Does T85.638A require prior authorization?

No, T85.638A does not require prior authorization (high confidence). Covered without prior authorization.

`T85.638A`, Leakage of other specified internal prosthetic devices, implants and grafts, initial encounter

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Claims for covered bariatric surgery must include three diagnosis codes with the primary diagnosis as E66.01, E66.812, or E66.813 and secondary/tertiary diagnoses from the specified ICD-10-CM code groups (group 1 and group 2).
When using CPT 43843 or CPT 43999 to bill a Not Otherwise Classified (NOC) or specific open procedures, include a note identifying the specific test/procedure performed in the Remarks area for Part A claims and the Narrative area for Part B claims.
Refer to LCD L35022 for complete reasonable-and-necessary documentation requirements and retain supporting medical records as required by Medicare policy.

Coverage for selected bariatric surgical procedures is allowed only for patients who meet the national and local reasonable-and-necessary criteria set forth in LCD L35022.
Claims for covered bariatric procedures must report three diagnoses: a primary diagnosis of morbid obesity (one of E66.01, E66.812, or E66.813), a secondary diagnosis from ICD-10-CM Code group 1, and a tertiary diagnosis from ICD-10-CM Code group 2.
Use CPT 43659 when both the gastric band and the subcutaneous port components were removed and replaced in the same encounter.
CT or MRI scans of the head or neck are covered when the medical record documents the scan is reasonable and necessary for diagnostic evaluation.
Coverage requires documentation supporting clinical indication such as history and physical exam findings, laboratory results, and signs or symptoms that justify the diagnostic test.
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.

NOVITAS-JH-L35022, Bariatric Surgical Management of Morbid Obesity

NOVITAS-JL-L35022, Bariatric Surgical Management of Morbid Obesity

A56422, Billing and Coding: Bariatric Surgical Management of Morbid Obesity

A57204, Billing and Coding: MRI and CT Scans of the Head and Neck

A57206, Billing and Coding: Lumbar MRI