Does S90.461A require prior authorization?

No, S90.461A does not require prior authorization (high confidence). Covered without prior authorization.

`S90.461A`, Insect bite (nonvenomous), right great toe, initial encounter

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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.

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.
Traditional negative pressure wound therapy (NPWT) devices, units, and supplies are covered under the Durable Medical Equipment (DME) benefit when they meet DME LCD coverage criteria and medical necessity.
CPT codes 97597, 97598, and wound debridement codes 11042-11047 may be covered when the medical record documents medical necessity consistent with L37228 Wound Care criteria and Medicare reasonable-and-necessary requirements.

CGS-J15-L34032, Debridement Services

J15

CGS-J18-L34032, Debridement Services

J18

WPS-J5-L37228, Wound Care

A56900, Billing and Coding: Immunizations

WPS-J5-L34596, Immunizations

A55909, Billing and Coding: Wound Care

WPS-J8-L34596, Immunizations

WPS-J8-L37228, Wound Care

AETNA-CPB-0650, Polymerase Chain Reaction Testing: Selected Indications

A52438, Billing and Coding: Tetanus Immunization

A56459, Billing and Coding: Debridement Services