Does S02.612S require prior authorization?

No, S02.612S does not require prior authorization (high confidence). Code is covered without prior authorization.

`S02.612S` — Fracture of condylar process of left mandible, sequela

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Maintain all documentation in the patient’s medical record; every page must be legible, include patient identification (e.g., full name, dates of service), and be made available to the contractor upon request.
Documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
The submitted medical record must support the use of the selected ICD-10-CM code(s).
The submitted CPT/HCPCS code must accurately describe the service performed.

Speech-language pathology (SLP) services for treatment or evaluation of communication disorders when determined reasonable and necessary per LCD L35070.
Selection and prescription of speech-generating devices should be billed with CPT code 92607.
Adaptation and training for speech-generating devices should be billed with CPT code 92609.
Report group therapy with CPT code 92508 when patients are not receiving direct one-on-one contact and are supervised by the therapist.
Use the appropriate CPT evaluation code for re-evaluations in SLP because CPT does not define a distinct re-evaluation code.
No specific clinical indications are listed in this billing/coding guidance; coverage determinations for MRI of the head and neck follow Local Coverage Determination L34425.

A54111 — Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders

J12

L35070 — Speech - Language Pathology (SLP) Services: Communication Disorders

J12

A56612 — Billing and Coding: CT of the Head

A56729 — Billing and Coding: Magnetic Resonance Imaging of the Head and Neck

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

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