Does S71.009A require prior authorization?

No, S71.009A does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

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`S71.009A`, Unspecified open wound, unspecified hip, initial encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Documentation Required

Claims must include a valid ICD-10-CM diagnosis code that best describes the condition prompting the immunization; claims without a valid diagnosis code will be returned as incomplete under Section 1833(e).
When a referring/ordering physician is required, the name and NPI of that physician must be reported on the claim.
For outpatient services likely to be noncovered, use ABN procedures: use modifier -GA with a signed CMS‑R‑131 ABN (or -GZ if no ABN), and for Part A submissions include occurrence code 32 and the ABN date.

Key Coverage Criteria

One tetanus booster dose is covered for a patient who completed primary immunization, has sustained a high‑risk wound (anaerobic conditions or probable exposure to tetanus spores), and has not received a booster within the past 5 years.
For clean, minor, uncontaminated wounds, a tetanus booster is covered only if the last booster was >10 years ago (booster every 10 years for most recipients).
Tetanus toxoid injections (including primary series completion) are covered when given for an acute injury if the patient has not received primary immunization or the patient's primary immunization status is unknown; unknown/uncertain histories should be treated as unvaccinated.
For inadequately vaccinated patients of any age, completion of the primary tetanus vaccination series should be ensured at discharge or follow-up after an injury and is covered in that context.
Skilled therapy services are covered when the skills of a qualified therapist are necessary to improve the patient’s current condition, to maintain the patient’s current condition, or to prevent or slow further deterioration.
Rehabilitative therapy is covered when therapist skills are necessary to safely and effectively furnish a recognized therapy service with the goal of improving an impairment or functional limitation.

4 Active Policies

A56566, Billing and Coding: Outpatient Physical and Occupational Therapy Services

A57064, Billing and Coding: Duplex Scan of Lower Extremity Arteries

A52438, Billing and Coding: Tetanus Immunization

A57067, Billing and Coding: Outpatient Physical and Occupational Therapy Services

`S71.009A`, Unspecified open wound, unspecified hip, initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

4 Active Policies

Related Codes

Have a follow-up question?

S71.009A, Unspecified open wound, unspecified hip, initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

4 Active Policies

Related Codes

Have a follow-up question?

`S71.009A`, Unspecified open wound, unspecified hip, initial encounter