Does S36.430A require prior authorization?

No, S36.430A does not require prior authorization (high confidence). Covered without prior authorization.

`S36.430A`, Laceration of duodenum, 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.
Follow LCD L35434 for reasonable and necessary requirements and supporting medical documentation for oximetry services.
Report overnight oximetry using CPT code 94762 on claims.
For decisions about preoperative biliary drainage: documentation of rationale for PBD if performed given evidence that routine PBD may increase infectious complications

Surgical resection of endocrine tumors (gastrinomas) including management of Zollinger-Ellison syndrome (ZES), with and without multiple endocrine neoplasia type 1 (MEN1)
Resection of intraductal papillary mucinous neoplasm (IPMN) of the pancreas
C24.1 Malignant neoplasm of ampulla of Vater
D13.2 Benign neoplasm of duodenum
D13.5 Benign neoplasm of extrahepatic bile ducts
Pancreaticoduodenectomy (also known as Whipple resection) : CPT codes covered if selection criteria are met : 48150 Pancreatectomy, proximal subtotal with total duodenectomy, partial gastrectomy, choledochoenterostomy and gastrojejunostomy (Whipple- hyphen type procedure); with pancreatojejunostomy

NOVITAS-JH-L35434, Oximetry Services

NOVITAS-JL-L35434, Oximetry Services

A57205, Billing and Coding: Oximetry Services

AETNA-CPB-0365, Pancreaticoduodenectomy (Whipple Resection)

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

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