Does S96.211A require prior authorization?

No, S96.211A does not require prior authorization (high confidence). Covered without prior authorization.

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`S96.211A`, Strain of intrinsic muscle and tendon at ankle and foot level, right foot, 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.
Injection therapy for Morton's neuroma (focal injection of tissue surrounding a localized plantar digital inflammatory focus) should be billed using CPT 64455 or 64632.
Injection therapy for plantar fasciitis is addressed and billed with CPT 20550 and corresponds to ICD-10-CM M72.2.
Injection to tendons at their origin or insertion sites should be reported using CPT 20551.
A single CPT 20551 should be reported when injections include both the plantar fascia and the area around a calcaneal spur.

5 Active Policies

NGS-J6-L33619, Nonvascular Extremity Ultrasound

A56787, Billing and Coding: Nonvascular Extremity Ultrasound

NGS-JK-L33619, Nonvascular Extremity Ultrasound

A57079, Billing and Coding: Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma

A57311, Billing and Coding: Physical Therapy - Home Health

`S96.211A`, Strain of intrinsic muscle and tendon at ankle and foot level, right foot, initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

5 Active Policies

Related Codes

Have a follow-up question?

S96.211A, Strain of intrinsic muscle and tendon at ankle and foot level, right foot, initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

5 Active Policies

Related Codes

Have a follow-up question?

`S96.211A`, Strain of intrinsic muscle and tendon at ankle and foot level, right foot, initial encounter