Does S32.402A require prior authorization?

No, S32.402A does not require prior authorization (high confidence). Covered without prior authorization.

`S32.402A`, Unspecified fracture of left acetabulum, initial encounter for closed fracture

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

This billing and coding article provides guidelines that complement Local Coverage Determination L34415 for CT of the abdomen and pelvis; consult LCD L34415 for specific coverage indications, limitations, and documentation requirements.
Claims and coding must follow and reference the Local Coverage Determination L33456; consult L33456 for specific clinical coverage criteria and required documentation.
All documentation must be maintained in the patient’s medical record and made available to the contractor upon request.

Coverage for lower extremity major joint replacement (hip and knee) is subject to the reasonable and necessary requirements of Local Coverage Determination L36007; services meeting LCD L36007 criteria are covered.
Total hip arthroplasty (THA) is covered for advanced hip joint disease when hip arthritis is documented by X-ray, MRI, or CT demonstrating one or more of: subchondral cysts, subchondral sclerosis, periarticular osteophytes, joint subluxation, degree of joint space narrowing, avascular necrosis, or bone-on-bone articulation.
THA is covered when the patient has hip pain or functional disability documented in context (e.g., pain interfering with ADLs, pain increased with initiation of activity, or pain increased with weight bearing).
THA is covered when documentation shows unsuccessful conservative (non-surgical) therapy as appropriate for the current episode (e.g., documented trial of NSAIDs or supervised physical therapy, or documented contraindication to such therapy).
THA is covered for joint malignancy when supporting evidence is in the record (e.g., pathology report and oncologist referral) demonstrating malignancy of the joint.
THA or revision/replacement is covered for acute or chronic fracture when imaging (e.g., X-ray) documents the fracture and justifies the procedure.

WPS-J5-L39911, Total Joint Arthroplasty

A59811, Billing and Coding: Total Joint Arthroplasty

WPS-J8-L39911, Total Joint Arthroplasty

A57765, Billing and Coding: Major Joint Replacement (Hip and Knee)

FIRST_COAST-L33618, Major Joint Replacement (Hip and Knee)

NOVITAS-JH-L36007, Lower Extremity Major Joint Replacement (Hip and Knee)

NOVITAS-JL-L36007, Lower Extremity Major Joint Replacement (Hip and Knee)

A56796, Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee)

A57683, Billing and Coding: Total Hip Arthroplasty

A56777, Billing and Coding: Total Joint Arthroplasty

A56421, Billing and Coding: CT of the Abdomen and Pelvis