Does S35.516A require prior authorization?

No, S35.516A does not require prior authorization (high confidence). Covered without prior authorization.

`S35.516A`, Injury of unspecified iliac vein, initial encounter

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
Every page of the medical record must be legible and include appropriate patient identification information (e.g., full name, dates of service).
Documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
The submitted medical record must support the use of the selected ICD-10-CM code(s).

Duplex scanning is covered only when it meets the reasonable and necessary requirements specified in Local Coverage Determination L33674.
Duplex scanning is covered to evaluate suspected chronic intestinal ischemia in patients with postprandial epigastric or periumbilical pain lasting 1–3 hours and associated weight loss from decreased oral intake.
Duplex scanning is covered to evaluate suspected acute intestinal ischemia in patients with acute crampy or steady epigastric/periumbilical pain with minimal abdominal exam findings and leukocytosis.
Duplex scanning is covered to evaluate possible injury to arterial inflow or venous outflow of abdominal, pelvic and/or retroperitoneal organs after trauma to those regions.
Duplex scanning is covered to evaluate suspected aneurysm of the renal artery or another visceral artery based on signs/symptoms or incidental radiologic finding.
Duplex scanning is covered to evaluate renovascular causes of uncontrolled hypertension in hypertensive patients who have failed first-line antihypertensive therapy (to rule out renal artery stenosis, renal arteriovenous fistula, or renal aneurysm).

FIRST_COAST-L33674, Duplex Scanning

A57636, Billing and Coding: Duplex Scanning

Ask Backwork about documentation requirements, denial risks, or coverage in your state.