Does T81.533A require prior authorization?

No, T81.533A does not require prior authorization (high confidence). Covered without prior authorization.

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`T81.533A`, Perforation due to foreign body accidentally left in body following injection or immunization, initial encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

This billing and coding article provides guidelines that complement Local Coverage Determination L34415 for CT of the abdomen and pelvis; consult LCD L34415 for specific coverage indications, limitations, and documentation requirements.
This article provides billing/coding guidelines that complement Local Coverage Determination L34417 for CT of the head; consult LCD L34417 for specific coverage, coding, and documentation requirements.
A legible medical record must document the condition, clinical findings, relevant prior treatment, and clearly justify the necessity and reasonableness of the lumbar MRI.

The documentation must clearly support the ICD-10-CM code(s) reported on the claim.

An attending or treating physician's order, properly signed and dated, is required for each lumbar MRI test.

Radiologists and ordering physicians must include sufficient clinical information in the MRI report to justify necessity; the MRI report or clinical record must document clinical findings and relevant prior treatment.

Key Coverage Criteria

Initial lumbar MRI is covered when the test is medically reasonable and necessary and the medical record documents clinical rationale and supports the ICD-10-CM code(s) billed.
A second lumbar MRI for the same patient is allowable when documentation shows comparative test results are needed to make a more definitive treatment decision.
Multiple scans of different body areas performed on the same day for the same patient are payable when each scan is reasonable and necessary.

3 Active Policies

A56421, Billing and Coding: CT of the Abdomen and Pelvis

A56612, Billing and Coding: CT of the Head

A57206, Billing and Coding: Lumbar MRI

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T81.533A, Perforation due to foreign body accidentally left in body following injection or immunization, initial encounter