Does T86.820 require prior authorization?

No, T86.820 does not require prior authorization (high confidence). Covered without prior authorization.

`T86.820`, Skin graft (allograft) rejection

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

The patient’s medical record must include the ordering provider’s assessment as it relates to the patient’s complaint for that visit.
Medical records must contain relevant medical history and results of pertinent tests or procedures performed.
For diagnostic tests, report the result of the test if known; otherwise report the symptoms that prompted performing the test.
All services ordered or rendered to Medicare beneficiaries must be signed and dated; include a signed and dated office visit record or operative report in the medical record.

A valid ICD-10-CM diagnosis code that best describes the patient’s condition for which the debridement service was performed must be reported on the claim.
When a service requires a referring or ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
Medicinal leech therapy is medically necessary for salvage of vascularly compromised flaps (muscle, skin, and fat tissue surgically removed from one part of body to another).
Medicinal leech (Hirudo medicinalis) therapy is medically necessary for any of the following conditions: poor venous drainage (venous congestion/venous outflow obstruction).
Medicinal leech therapy is medically necessary for salvage of vascularly compromised replants (limbs or other body parts re-attached after traumatic amputation).
Medical maggots (larval therapy) are medically necessary for debridement of non-healing necrotic skin and soft tissue wounds including chronic diabetic foot ulcers.

CGS-J15-L34032, Debridement Services

J15

CGS-J18-L34032, Debridement Services

J18

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

AETNA-CPB-0175, Pulsed Electromagnetic Stimulation

AETNA-CPB-0556, Bio-Surgery: Medicinal Leech Therapy and Medical Maggots

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