Does T83.193A require prior authorization?

No, T83.193A does not require prior authorization (high confidence). Covered without prior authorization.

Backwork Sign up free

`T83.193A`, Other mechanical complication of other urinary stent, 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.
The ordering physician/nonphysician practitioner must state the clinical indication and medical necessity for the study in the order.
The performing provider must maintain a permanent record of the performed study and interpretation, and must retain a copy of the ordering provider’s order and the test results.

The report must describe the studies performed, note any contrast media or radiopharmaceuticals used, record any significant patient reactions or complications, and compare with prior relevant imaging.

Variations from normal size must be documented with measurements and the report should address specific clinical questions or explain why questions cannot be answered.

Retention of ultrasound images must comply with clinical need and applicable legal and local facility requirements, and results of all testing must be shared with the referring physician.

Key Coverage Criteria

Non‑invasive abdominal/visceral vascular studies are covered when the test results will be used to directly inform or change the patient's clinical management.
A preoperative non‑invasive abdominal/visceral vascular study is covered as reasonable and necessary for patients undergoing bypass surgery (one preoperative scan considered reasonable).
Medically necessary follow‑up non‑invasive abdominal/visceral vascular studies after angioplasty are covered as indicated by the vascular distribution treated.
Non‑invasive abdominal/visceral vascular studies performed in the inpatient hospital (place of service 21) or emergency room (place of service 23) are permitted and are not subject to the routine once‑per‑year outpatient limitation.
Outpatient urine culture testing for bacteria is consideredmedically necessaryto evaluate any of the following situations:
Clinical signs or symptoms suggesting urinary tract infection (UTI);or

5 Active Policies

WPS-J5-L35755, Non-Invasive Abdominal / Visceral Vascular Studies

A57591, Billing and Coding: Non-Invasive Abdominal / Visceral Vascular Studies

WPS-J8-L35755, Non-Invasive Abdominal / Visceral Vascular Studies

ANTHEM-CG-LAB-24, Outpatient Urine Culture

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

Have a follow-up question?

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

Ask Backwork about T83.193A Sign up free

T83.193A, Other mechanical complication of other urinary stent, initial encounter