Does T76.21XS require prior authorization?

No, T76.21XS does not require prior authorization (high confidence). Covered without prior authorization.

`T76.21XS`, Adult sexual abuse, suspected, sequela

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

The medical record must fully support medical necessity and include relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
For services requiring a referring/ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.
For diagnostic tests, report the test result if known; otherwise report the presenting symptoms that prompted the test.
Providers are exempt from submitting psychotherapy notes without patient authorization when notes meet the Privacy Rule definition in 45 CFR 164.501; the provider is responsible for extracting information required for coverage determinations.

Psychiatric/psychological services are covered when there is a reasonable expectation that withdrawing treatment would cause the patient's condition to deteriorate, relapse, or require hospitalization.
CORF social and psychological services are covered when indicated and may be provided by qualified social workers (minimum BS) or psychologists (minimum Master’s level).
Psychiatric diagnostic procedures may be billed once per day and are covered at the outset of an illness or suspected illness, or again for a new episode after a hiatus or on (re)admission for complications of the underlying condition.
Psychotherapy codes that include an E/M component are payable when performed by physicians, physician assistants (PA), nurse practitioners (NP), or clinical nurse specialists (CNS) and the E/M component is documented in the record.
Interactive complexity add-on code 90785 may be reported in conjunction with specified diagnostic and psychotherapy codes when interactive complexity is present.
External ocular photography is covered when ordered by an authorized/referring provider to document, diagnose, or monitor an ocular condition and when medical record documentation supports medical necessity.

CGS-J15-L39038, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

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CGS-J15-L34393, Ocular Photography - External

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CGS-J18-L39038, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

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CGS-J18-L34393, Ocular Photography - External

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Ask Backwork about documentation requirements, denial risks, or coverage in your state.