Does T23.399S require prior authorization?

No, T23.399S does not require prior authorization (high confidence). Covered without prior authorization.

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`T23.399S`, Burn of third degree of multiple sites of unspecified wrist and hand, sequela

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

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.
Clinical trial/reporting deficiencies noted: many studies lacked standardized reporting of laser parameters, allocation concealment, blinding, withdrawals, and treatment protocols — implying that documentation of laser parameters (wavelength, power, J/cm2, duration, frequency) would be important though not formally required in this text.
No documentation requirements, billing criteria, ICD-10/CPT codes, or explicit medical necessity documentation instructions are specified in this document.

Clinical notes supporting medical necessity and that the patient meets any applicable selection criteria (the CPB references 'selection criteria' for coverage of CPT 0552T but the selection criteria text is not included in this chunk).

Documentation of the specific laser therapy modality and parameters used (device, wavelength, dosing) and treatment dates to support billing of CPT 0552T when covered.

If billed, supporting documentation to show the service is not being used for indications listed as experimental/investigational in the policy (e.g., no documentation of using LLLT for conditions in the excluded list).

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.
Peri-implant mucositis (p-iM)
Aggressive periodontitis (as adjunct to scaling and root planing [SRP])
Skin burns (experimental models; LLLT to accelerate healing)
Tendon repair (animal models; LLLT often studied alone or combined with adipose-derived mesenchymal stem cells)
Brain photobiomodulation / transcranial LLLT for traumatic brain injury (TBI), Alzheimer disease (AD), depression, Parkinson disease (PD), stroke, and cognitive enhancement

5 Active Policies

ANTHEM-CG-MED-73, Hyperbaric Oxygen Therapy (Systemic/Topical)

ANTHEM-CG-SURG-127, Products for Wound Healing and Soft Tissue Grafting: Medically Necessary Uses

AETNA-CPB-0244, Skin and Soft Tissue Substitutes

AETNA-CPB-0363, Cold Laser and High-Power Laser Therapies

A59186, Billing and Coding: Magnesium

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T23.399S, Burn of third degree of multiple sites of unspecified wrist and hand, sequela