Does S15.091A require prior authorization?

No, S15.091A does not require prior authorization (high confidence). Code is covered without prior authorization.

`S15.091A` — Other specified injury of right carotid artery, initial encounter

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

When billing these procedures after carotid endarterectomy, include the surgery date and the phrase 'carotid endarterectomy' in the claim narrative.
When reporting a reduced (unilateral/limited) service, append modifier -52 and include an explanation of the reduced service in Item 19 of the CMS-1500 form or electronic equivalent; any appropriate supporting documentation may be submitted with the claim.
Follow Novitas LCD L35397 for the reasonable and necessary documentation requirements and frequency limitations, and consult NCCI edits for correct coding combinations prior to billing Medicare.
Claims must meet the reasonable and necessary documentation requirements specified in LCD L35035; include clinical records demonstrating medical necessity per the LCD.

Non-invasive cerebrovascular arterial studies are covered when reasonable and necessary as defined by Novitas Local Coverage Determination (LCD) L35397.
Duplex post-interventional follow-up studies (typically limited and unilateral) are covered for evaluation after cerebrovascular intervention.
Vascular studies performed after carotid endarterectomy are covered when the claim includes the procedure date and the narrative 'carotid endarterectomy.'
Coverage for thoracic aortography and carotid, vertebral, and subclavian angiography is determined by Local Coverage Determination L35035; services are covered when reasonable and necessary per that LCD.
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.

A57592 — Billing and Coding: Non-Invasive Cerebrovascular Studies

J05

L35753 — Non-Invasive Cerebrovascular Studies

J05

A56758 — Billing and Coding: Non-Invasive Vascular Studies

J06

A56747 — Billing and Coding: Magnetic Resonance Angiography (MRA)

J06

L33633

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