Does P13.0 require prior authorization?

No, P13.0 does not require prior authorization (high confidence). Code is covered without prior authorization.

`P13.0` — Fracture of skull due to birth injury

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

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.
Medical record documentation must demonstrate clinical evidence of an intracranial disorder or documentation of an established intracranial disease to support coverage of cranial CT.
When contrast-enhanced CT is ordered for staging, documentation must record the known primary cancer (e.g., lung cancer, breast cancer, lymphoma) and clinical rationale for brain staging.
When contrast is used to assess perfusion, lesion characterization, blood–brain barrier defects, or neovascularity, the clinical indication for contrast administration should be documented.

Cranial CT (with or without contrast) is covered when the patient has clinical evidence of an intracranial disorder or an established intracranial disorder/disease.
Contrast-enhanced CT is reasonable and necessary to assess cerebral perfusion, for example in suspected or known cerebrovascular accident (CVA).
Contrast-enhanced CT is covered to characterize a specific intracranial lesion.
Contrast-enhanced CT is covered to detect blood–brain barrier defects such as infarcts, tumors, infection, or vasculitis.
Contrast-enhanced CT is covered to detect neovascularity associated with intracranial tumors.
Contrast-enhanced CT is covered for staging when there is known primary lung cancer, breast cancer, or lymphoma that are likely to metastasize early to the brain.

ANTHEM-GL-C159218 — CG-OR-PR-04 Cranial Remodeling Bands and Helmets (Cranial Orthoses)

A56612 — Billing and Coding: CT of the Head

L34417 — CT of the Head

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