Does S32.491A require prior authorization?

No, S32.491A does not require prior authorization (high confidence). Covered without prior authorization.

`S32.491A`, Other specified fracture of right 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.
Initial lumbar MRI is covered when the test is medically reasonable and necessary and the medical record documents clinical rationale and supports the ICD-10-CM code(s) billed.
A second lumbar MRI for the same patient is allowable when documentation shows comparative test results are needed to make a more definitive treatment decision.
Multiple scans of different body areas performed on the same day for the same patient are payable when each scan is reasonable and necessary.
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).

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)

A57206, Billing and Coding: Lumbar MRI

A57683, Billing and Coding: Total Hip Arthroplasty

A56777, Billing and Coding: Total Joint Arthroplasty

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