Does S06.38AD require prior authorization?

No, S06.38AD does not require prior authorization (high confidence). Code is covered without prior authorization.

`S06.38AD` — Contusion, laceration, and hemorrhage of brainstem with loss of consciousness status unknown, subsequent encounter

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

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).

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.

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)

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