Does S36.531A require prior authorization?

No, S36.531A does not require prior authorization (high confidence). Covered without prior authorization.

`S36.531A`, Laceration of transverse colon, 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 services ordered or rendered must be signed and dated in the medical record, including a signed and dated office visit record or operative report.
An Advance Beneficiary Notice (ABN), Form CMS-R-131, should be signed by the beneficiary when applicable to indicate acceptance of financial responsibility.
The patient's medical record must include the ordering provider's assessment as it relates to the patient's complaint for that visit.

Colonoscopy/sigmoidoscopy/proctosigmoidoscopy is covered for surveillance of colonic neoplasia in patients with a history of colorectal cancer or colonic polyps.
A follow-up procedure is covered 1 year after surgery for treatment of colorectal cancer when the patient is identified as high-risk for colon cancer and is eligible for continued screenings.
Evaluation of an anorectal adenomatous polyp is covered (adenomatous polyps only).
Colonoscopy/sigmoidoscopy/proctosigmoidoscopy is covered to evaluate an abnormality on barium enema or other imaging likely to be clinically significant (e.g., filling defect, stricture, or inadequate exam).
Evaluation of unexplained gastrointestinal bleeding, including hematochezia not thought to be from a rectal/perianal source or melena of unknown origin, is covered.
Colonoscopy is covered for investigation of a positive fecal occult blood test.

CGS-J15-L34005, Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy

J15

CGS-J18-L34005, Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy

J18

NOVITAS-JH-L35434, Oximetry Services

A57205, Billing and Coding: Oximetry Services

NOVITAS-JL-L35434

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