Does S32.611B require prior authorization?

No, S32.611B does not require prior authorization (high confidence). Covered without prior authorization.

`S32.611B`, Displaced avulsion fracture of right ischium, initial encounter for open 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.
Billing and coding for immunizations must follow the coverage indications, limitations, and medical necessity criteria set forth in the associated Local Coverage Determination LCD L34596 (Immunizations).
A legible medical record must document the condition, clinical findings, relevant prior treatment, and clearly justify the necessity and reasonableness of the lumbar MRI.

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.
Beneficiary is confined to the home to qualify for the Medicare home health PPS benefit.
Beneficiary is under the care of a physician.
Beneficiary is receiving services under a plan of care that is established and periodically reviewed by a physician.

CGS-J15-L40232, Total Joint Arthroplasty

J15

CGS-J18-L40232, Total Joint Arthroplasty

J18

A59811, Billing and Coding: Total Joint Arthroplasty

A56900, Billing and Coding: Immunizations

WPS-J5-L34596, Immunizations

WPS-J5-L39911, Total Joint Arthroplasty

WPS-J8-L39911, Total Joint Arthroplasty

WPS-J8-L34596, Immunizations

A58873, Billing and Coding: Tetanus Immunization

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

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

A58872, Billing and Coding: Tetanus Immunization

A60250, Billing and Coding: Total Joint Arthroplasty

A57206, Billing and Coding: Lumbar MRI

A57311, Billing and Coding: Physical Therapy - Home Health

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