Does S61.409A require prior authorization?

No, S61.409A does not require prior authorization (high confidence). Covered without prior authorization.

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`S61.409A`, Unspecified open wound of unspecified hand, initial encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

"Medically necessary" or "medical necessity" definition must be met and documented: clinical rationale consistent with generally accepted standards of medical practice, clinically appropriate in terms of type, frequency, extent, site, and duration, effective for the patient's illness/injury/ disease, not primarily for convenience, and not more costly than an alternative service.
The patient's medical records should document the practitioner's clinical rationale for performing the specific strapping or taping procedures, as well as the patient's response.
Any time taping is done, the health care record must clearly document the specific reasons for, and location of, the taping.

If the service that includes the taping is billed to a payor, the taping must be consistent with the documented chief complaint / clinical examination findings, diagnosis and treatment plan.

The assessment supporting medical necessity should be established through history and objective evaluation.

A treatment plan with goals and objective measures, including time frames, must be documented after medical necessity is established.

Key Coverage Criteria

Strapping is considered medically necessary for the management of immobilization of a joint and restriction of movement with strapping tape (i.e., rigid, non-elastic or non-stretchy tape) for ANY of the following indications:
Strapping of hand or finger (CPT code 29280) for: fracture of finger
Strapping of hand or finger (CPT code 29280) for: dislocation of finger
Strapping/taping of ankle or foot (CPT code 29540) for: acute sprains and strains of ankle and foot
Strapping/taping of ankle or foot (CPT code 29540) for: dislocations of ankle and foot
Strapping/taping of ankle or foot (CPT code 29540) for: fractures of ankle and foot

1 Active Policy

CIGNA-CPG143, Strapping and Taping

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S61.409A, Unspecified open wound of unspecified hand, initial encounter