Does I97.42 require prior authorization?

No, I97.42 does not require prior authorization (high confidence). Code is covered without prior authorization.

`I97.42` — Intraoperative hemorrhage and hematoma of a circulatory system organ or structure complicating other procedure

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

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.
The ordering/referring practitioner's assessment related to the patient's complaint and the specific reason for the test must be documented in the medical record.
The medical record must contain a referral/order on file for each non‑invasive vascular study performed.

Non-invasive vascular diagnostic tests are covered when ordered by the treating practitioner or a consulting physician who will use the results to manage the beneficiary's specific medical problem.
A documented referral/order must be on record for each individual non-invasive vascular study performed for coverage to apply.
Cerebrovascular arterial duplex follow-up is covered annually for stenosis 20–49% (diameter reduction).
Cerebrovascular arterial duplex follow-up is covered every six months for stenosis 50–79% (diameter reduction).
Cerebrovascular arterial duplex follow-up is covered every six months for stenosis 80–99% if surgical correction has not been performed.
After carotid endarterectomy, repeat ipsilateral (unilateral) duplex examinations are allowable at approximately six weeks, six months, and one year post‑procedure during the first year.

L35761 — Non-Invasive Peripheral Arterial Vascular Studies

J05

L35751 — Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies

J05

A57593 — Billing and Coding: Non-Invasive Peripheral Arterial Vascular Studies

J05

A57594 — Billing and Coding: Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies

J05

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