Does S36.116A require prior authorization?

No, S36.116A does not require prior authorization (high confidence). Covered without prior authorization.

`S36.116A`, Major laceration of liver, initial encounter

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.
All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
Every page of the record must be legible and include appropriate patient identification information such as complete name and dates of service.
The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.

Diagnostic abdominal aortography and renal angiography are covered when they meet the reasonable and necessary clinical requirements specified in LCD L35092.
When femoral or iliac angiography is performed at the time of coronary angiography, bill using HCPCS code G0278.
Bill HCPCS code G0278 for femoral or iliac angiography performed at the time of coronary angiography.
Aortography and peripheral angiography are covered when reasonable and necessary per Local Coverage Determination L36767 and when documentation supports the selected ICD-10-CM diagnosis and medical necessity.
Selective renal angiography is medically necessary for renovascular occlusive disease including renal artery stenosis, severe or difficult-to-control renal hypertension, resistant hypertension, or progressive renal insufficiency.
Selective renal angiography is medically necessary for renal aneurysm, renovascular trauma, primary vascular abnormalities (aneurysms, vascular malformations, vasculitis), renal neoplasm, hematuria of unknown cause, and other intrinsic renal defects prior to intervention.

A57056, Billing and Coding: Aortography and Peripheral Angiography

FIRST_COAST-L36767, Aortography and peripheral angiography

NOVITAS-JH-L35434, Oximetry Services

NOVITAS-JH-L35092, Diagnostic Abdominal Aortography and Renal Angiography

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