Does S63.638A require prior authorization?

No, S63.638A does not require prior authorization (high confidence). Covered without prior authorization.

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`S63.638A`, Sprain of interphalangeal joint of other finger, initial encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

The patient's medical record must contain documentation that fully supports medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Each claim must be submitted with ICD-10-CM codes that reflect the patient's condition and the reason for the service; claims without ICD-10-CM codes will be returned.
For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.

A permanent record of the ultrasound and its interpretation must be kept in the patient's record, including images labeled with exam date, patient identification, and image orientation; documentation of variations from normal with measurements; and a formal interpretation.

Key Coverage Criteria

Nonvascular extremity ultrasound is covered when medical necessity is documented in the patient's record, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Diagnostic nonvascular extremity ultrasound is covered when the claim includes an ICD-10-CM diagnosis code that best describes the patient's condition and the test result or the symptoms prompting the test are documented.
Extremity ultrasound is indicated to detect and evaluate cysts, abscesses, tumors (including assessment of tumor size), and joint or soft-tissue effusions in the arms and legs.
Extremity ultrasound is indicated to distinguish solid masses from fluid-filled cysts and evaluate soft-tissue masses, ganglion cysts, intermetatarsal neuromas, and stress fractures of the metatarsals.
Extremity ultrasound is indicated to evaluate tendons (including tears, tendonitis, tenosynovitis), joints, plantar fascia, and ligaments in the arms and legs.
Extremity ultrasound is indicated to aid in the diagnosis and to assist surgical removal/localization of foreign bodies in the extremities.

3 Active Policies

NGS-J6-L33619, Nonvascular Extremity Ultrasound

A56787, Billing and Coding: Nonvascular Extremity Ultrasound

NGS-JK-L33619, Nonvascular Extremity Ultrasound

`S63.638A`, Sprain of interphalangeal joint of other finger, initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

3 Active Policies

Related Codes

Have a follow-up question?

S63.638A, Sprain of interphalangeal joint of other finger, initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

3 Active Policies

Related Codes

Have a follow-up question?

`S63.638A`, Sprain of interphalangeal joint of other finger, initial encounter