Does S39.093S require prior authorization?

No, S39.093S does not require prior authorization (high confidence). Covered without prior authorization.

`S39.093S`, Other injury of muscle, fascia and tendon of pelvis, sequela

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.
A legible medical record must document the condition, clinical findings, relevant prior treatment, and clearly justify the necessity and reasonableness of the lumbar MRI.
The documentation must clearly support the ICD-10-CM code(s) reported on the claim.
An attending or treating physician's order, properly signed and dated, is required for each lumbar MRI test.

Initial lumbar MRI is covered when the test is medically reasonable and necessary and the medical record documents clinical rationale and supports the ICD-10-CM code(s) billed.
A second lumbar MRI for the same patient is allowable when documentation shows comparative test results are needed to make a more definitive treatment decision.
Multiple scans of different body areas performed on the same day for the same patient are payable when each scan is reasonable and necessary.
An ECG is covered when the result is relevant to the management, diagnosis, or treatment of the patient.
A separate ECG on the same day as a cardiac stress test is payable only when it provides additional clinically necessary information beyond the stress test (e.g., to rule out acute myocardial infarction prior to performing the stress test).
Rhythm ECGs are covered when used to evaluate signs or symptoms suggesting a cardiac rhythm disorder.

AETNA-CPB-0210, Phonophoresis

AETNA-CPB-0363, Cold Laser and High-Power Laser Therapies

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

A57206, Billing and Coding: Lumbar MRI

A57326, Billing and Coding: Electrocardiograms

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