S06.2XAD — Diffuse traumatic brain injury with loss of consciousness status unknown, subsequent encounter
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- The diagnosis code(s) billed must best describe the patient’s condition for which the SCODI service was performed.
- The patient's medical record must contain documentation that fully supports the medical necessity for SCODI services included within LCD L34380, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
- For services requiring a referring or ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
- Document evaluations and re-evaluations and bill re-evaluations using the evaluation CPT code (per policy guidance).
Key Coverage Criteria
- Scanning computerized ophthalmic diagnostic imaging (SCODI) is covered when the service meets the medical necessity criteria and is included within Local Coverage Determination L34380.
- Coverage for programming and modification of speech-generating devices using CPT 92609.
- Coverage for individual outpatient treatment of speech, language, voice, communication, and/or auditory processing disorders using CPT 92507.
- Coverage for group outpatient treatment (2 or more individuals) of speech, language, voice, communication, and/or auditory processing disorders using CPT 92508.
- Coverage for selection and prescription of speech-generating devices (SGDs) using CPT 92607 and 92608.
- Psychiatric/psychological services are covered when there is a reasonable expectation that withdrawing treatment would cause the patient's condition to deteriorate, relapse, or require hospitalization.
20 Active Policies
A57483 — Billing and Coding: Visual Fields
J05
L34615 — Visual Fields
J05
A56537 — Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
J06
L33632 — Psychiatry and Psychology Services
J06
L34380 — Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
Related Codes
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