Does T20.011A require prior authorization?

No, T20.011A does not require prior authorization (high confidence). Covered without prior authorization.

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`T20.011A`, Burn of unspecified degree of right ear [any part, except ear drum], initial encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Billing and coding for immunizations must follow the coverage indications, limitations, and medical necessity criteria set forth in the associated Local Coverage Determination LCD L34596 (Immunizations).
The article provides billing/coding guidance that complements LCD L39400; use the documentation, prior authorization, and claim submission requirements specified in LCD L39400 and the local contractor's instructions.
Product-specific application details: documentation of product lot, size, number of applications, fixation method (sutures, staples, adhesives), and whether single or multiple applications were performed (many devices are single-use and dosage is per cm2 or per mg for particulates).

For use of biologic implants/allografts/xenografts: documentation of patient allergies or sensitivities (e.g., known porcine sensitivity excludes Mediskin), informed consent noting product source (human, porcine, bovine, ovine), and rationale for selection.

Key Coverage Criteria

No specific clinical indications are listed in this article; follow the Local Coverage Determination (LCD) L39400 for indications for magnesium testing or services.
Use of acellular human dermal allograft in rhinoplasty
Healing septal perforations using acellular dermis as bioscaffold
Artiss is approved for attachment of skin grafts onto burn patients (clinical trial basis described).
AlloSkin: As an allogeneic human, cadaver-derived skin graft for the management of traumatic skin wounds and burn wounds if the wound is too large for autograft. (Note: not AlloSkin AC or AlloSkin RT, which are different products).
AmnioBand: For the treatment of: Difficult-to-heal chronic venous partial and full-thickness ulcers of the lower extremity that have failed standard wound therapy of at least 4-weeks duration; Partial and full‐thickness neuropathic diabetic foot ulcers that are greater than 6 weeks in duration with no capsule, tendon or bone exposed, when used in conjunction with standard diabetic ulcer care.

5 Active Policies

WPS-J5-L34596, Immunizations

A56900, Billing and Coding: Immunizations

WPS-J8-L34596, Immunizations

AETNA-CPB-0244, Skin and Soft Tissue Substitutes

A59186, Billing and Coding: Magnesium

`T20.011A`, Burn of unspecified degree of right ear [any part, except ear drum], initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

5 Active Policies

Related Codes

Have a follow-up question?

T20.011A, Burn of unspecified degree of right ear [any part, except ear drum], initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

5 Active Policies

Related Codes

Have a follow-up question?

`T20.011A`, Burn of unspecified degree of right ear [any part, except ear drum], initial encounter