Does S92.819S require prior authorization?

No, S92.819S does not require prior authorization (high confidence). Covered without prior authorization.

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`S92.819S`, Other fracture of unspecified foot, sequela

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

All documentation must be maintained in the patient's medical record, legible, include patient identification (e.g., full name, dates of service), and be made available to the contractor upon request.
The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing the patient's care.
The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
The ordering/referring physician/nonphysician practitioner must state the reason for the duplex scan in the order and provide relevant diagnostic information to the performing provider.

Key Coverage Criteria

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.
Medicare allows ultrasonic osteogenesis stimulators only if all of the following criteria are met: nonunion of a fracture documented by a minimum of two sets of radiographs obtained prior to starting treatment with the osteogenic stimulator, separated by a minimum of 90 days; and the fracture is not of the skull or vertebrae; and the fracture is not tumor related.
Covered CPT/HCPCS codes for electrical stimulation if selection criteria are met: CPT 20974 (electrical stimulation noninvasive), CPT 20975 (invasive operative); HCPCS E0747 (electrical, noninvasive, non-spinal applications), E0748 (electrical, noninvasive, spinal applications), E0749 (electrical, surgically implanted).
Examples of covered diagnoses (ICD-10 codes listed as covered if selection criteria are met) include spondylolisthesis (M43.10-M43.19), malunion of fracture, nonunion of fracture, congenital pseudarthrosis/other congenital malformations of limbs (Q74.0-Q74.9), congenital spondylolisthesis (Q76.2), Colles fracture (S52.531+ - S52.539+), scaphoid fracture (S62.001+ - S62.036+), fractures of tibia (S82.101+ - S82.299+), medial malleolus, fibula fractures, pilon fracture of tibia, Jones (5th metatar [...]
Electrical stimulation for spine fusion when any of the following indications are met: failed spinal fusion where a minimum of nine months has elapsed since the last surgery; or following a multilevel spinal fusion surgery; or following spinal fusion surgery where there is a history of a previously failed spinal fusion at the same site (Medicare note: a multilevel spinal fusion is one which involves 3 or more vertebrae).
Non-spinal electrical stimulation (Medicare-supported indications): nonunion of a long bone fracture, defined as radiographic evidence that fracture healing has ceased for three or more months prior to starting treatment with the osteogenesis stimulator; or failed fusion of a joint other than in the spine where a minimum of nine months has elapsed since the last surgery; or congenital pseudarthrosis.

2 Active Policies

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

AETNA-CPB-0343, Bone Growth Stimulators

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S92.819S, Other fracture of unspecified foot, sequela