Does S37.001S require prior authorization?

No, S37.001S does not require prior authorization (high confidence). Covered without prior authorization.

`S37.001S`, Unspecified injury of right kidney, sequela

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Medical records must document that the ultrasound was limited to retroperitoneal structures when billing CPT 76770/76775/76776, including images/findings demonstrating limitation to the retroperitoneum.
If the exam was expanded to include organs outside the retroperitoneum, documentation must reflect the expansion and support billing a full or limited abdominal ultrasound (CPT 76700/76705/76706).
Claims and documentation should follow the complementary Local Coverage Determination L34577 and any applicable LCD requirements.
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.

Retroperitoneal ultrasound (CPT 76770, 76775, 76776) is covered when the exam is limited solely to retroperitoneal structures.
A full (complete) or limited abdominal ultrasound (CPT 76700, 76705, 76706) is covered when the exam includes organs or structures outside the retroperitoneum or when primary findings involve non-retroperitoneal structures (e.g., gallbladder, liver, spleen, common bile duct).
Magnetic resonance angiography (MRA) is covered only when the service meets the reasonable and necessary coverage criteria specified in Local Coverage Determination L34865.
MRA is appropriate to verify the presence of a vascular condition suspected on prior testing (usually another imaging study) rather than as an initial screening test.
Head/neck MRA is indicated to evaluate carotid stenosis for possible surgical or percutaneous intervention when noninvasive testing (eg, Doppler ultrasound) demonstrates carotid stenosis or when clinical findings (eg, carotid bruit) corroborate stenosis.
Head MRA (or cerebral angiogram) is indicated to evaluate for an intracranial aneurysm when there is clinically significant subarachnoid blood on CSF testing or signs/symptoms strongly suggesting an unruptured intracranial aneurysm.

NOVITAS-JH-L34865, Magnetic Resonance Angiography (MRA)

NOVITAS-JL-L34865, Magnetic Resonance Angiography (MRA)

A56805, Billing and Coding: Magnetic Resonance Angiography (MRA)

A55336, Billing and Coding: Retroperitoneal Ultrasound

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

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