Does S85.801A require prior authorization?

No, S85.801A does not require prior authorization (high confidence). Covered without prior authorization.

`S85.801A`, Unspecified injury of other blood vessels at lower leg level, right leg, initial encounter

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

The medical record must contain relevant medical history, physical examination, and results of pertinent diagnostic tests that fully support the medical necessity of each non-invasive vascular study.
Diagnostic tests must be ordered by the treating practitioner (or consulting physician) who will use the test results in managing the patient's specific medical problem; the ordering practitioner's name and NPI must be reported on the claim when required.
Providers of interpretations and technical personnel must maintain documentation of training, licensure, certification, and proficiency for post-payment audit; IDTF supervising physicians must document proficiency in each diagnostic procedure performed.

Non-invasive vascular studies (duplex scan, physiologic studies, plethysmography, transcranial Doppler) are covered when ordered by the treating or consulting practitioner and medically necessary to evaluate, diagnose, or manage vascular disease.
Initial autogenous access vessel mapping should be billed with HCPCS codes 93985 or 93986 and is covered when medically necessary for surgical planning.
Subsequent autogenous access mapping may be billed with CPT codes 93970 or 93971 when clinically indicated.
Pre-surgical radial artery conduit mapping may be performed and accompanied by vein-mapping when either study shows insufficient conduits for multiple bypass procedures.
Immediate post-operative studies of an access or bypass site are covered if pulses are lost, become equivocal, or the patient develops signs or symptoms of ischemia suggesting need for repeat intervention.
Duplex scan of lower extremity arteries is covered when medically necessary per LCD L33667, with the ordering/referring provider documenting signs and symptoms, relevant history (including known diagnoses and/or prior imaging) supporting evaluation of lower extremity arterial disease.

NGS-J6-L33627, Non-Invasive Vascular Studies

A56758, Billing and Coding: Non-Invasive Vascular Studies

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

NGS-JK-L33627, Non-Invasive Vascular Studies