Does S35.8X8D require prior authorization?

No, S35.8X8D does not require prior authorization (high confidence). Covered without prior authorization.

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`S35.8X8D`, Other specified injury of other blood vessels at abdomen, lower back and pelvis level, subsequent encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

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.
The medical record must contain relevant medical history, physical examination, and results of pertinent diagnostic tests that fully support the medical necessity of each non-invasive vascular study.
Diagnostic tests must be ordered by the treating practitioner (or consulting physician) who will use the test results in managing the patient's specific medical problem; the ordering practitioner's name and NPI must be reported on the claim when required.

Providers of interpretations and technical personnel must maintain documentation of training, licensure, certification, and proficiency for post-payment audit; IDTF supervising physicians must document proficiency in each diagnostic procedure performed.

Key Coverage Criteria

Non-invasive vascular studies (duplex scan, physiologic studies, plethysmography, transcranial Doppler) are covered when ordered by the treating or consulting practitioner and medically necessary to evaluate, diagnose, or manage vascular disease.
Initial autogenous access vessel mapping should be billed with HCPCS codes 93985 or 93986 and is covered when medically necessary for surgical planning.
Subsequent autogenous access mapping may be billed with CPT codes 93970 or 93971 when clinically indicated.
Pre-surgical radial artery conduit mapping may be performed and accompanied by vein-mapping when either study shows insufficient conduits for multiple bypass procedures.
Immediate post-operative studies of an access or bypass site are covered if pulses are lost, become equivocal, or the patient develops signs or symptoms of ischemia suggesting need for repeat intervention.
Non-invasive vascular studies are medically necessary when the ordering physician reasonably expects test outcomes will potentially impact clinical management and significant signs or symptoms of arterial or venous disease are present, and the test is not redundant of other required diagnostics.

4 Active Policies

NGS-J6-L33627, Non-Invasive Vascular Studies

A56758, Billing and Coding: Non-Invasive Vascular Studies

NGS-JK-L33627, Non-Invasive Vascular Studies

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

`S35.8X8D`, Other specified injury of other blood vessels at abdomen, lower back and pelvis level, subsequent encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

4 Active Policies

Related Codes

Have a follow-up question?

S35.8X8D, Other specified injury of other blood vessels at abdomen, lower back and pelvis level, subsequent encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

4 Active Policies

Related Codes

Have a follow-up question?

`S35.8X8D`, Other specified injury of other blood vessels at abdomen, lower back and pelvis level, subsequent encounter