Does S16.9XXA require prior authorization?

No, S16.9XXA does not require prior authorization (high confidence). Code is covered without prior authorization.

`S16.9XXA` — Unspecified injury of muscle, fascia and tendon at neck level, initial encounter

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

List the appropriate CPT code for the procedure and include any applicable modifiers; adhere to Medicare global surgery and CCI (correct coding initiative) rules for eyelid surgeries.
Submit physicians' services and diagnostic tests with a diagnosis code that supports medical necessity and code to the greatest level of specificity (full digit completeness).
Use the diagnosis code based on diagnostic test results as the primary diagnosis; if test results are normal or inconclusive, use the diagnosis code for the sign or symptom that prompted the test as the primary diagnosis.
When signs or symptoms are present, place the appropriate definitive diagnosis code in the first position and an available symptom diagnosis code in the second position on CMS-1500 item 21 (or electronic equivalent).

Blepharoplasty, blepharoptosis repair, or brow lift is covered when documented signs or symptoms of a functional abnormality of the upper eyelids are present as defined by the associated LCD (L34528).
Esophagogastroduodenoscopy (EGD) is covered when it meets the reasonable and necessary requirements specified in Local Coverage Determination L33583.
EGD is covered for persistent upper abdominal distress (e.g., gastroesophageal reflux disease) that continues despite an appropriate trial of symptomatic therapy.
EGD is covered for upper abdominal distress accompanied by a short history of concerning signs or symptoms such as weight loss, anorexia, vomiting, or NSAID/other gastric irritant intake.
EGD is covered for patients older than 40 years who have a significant history of heartburn that recurs after a course of symptomatic therapy.
EGD is covered for patients with dysphagia or odynophagia.

A56908 — Billing and Coding: Blepharoplasty, Blepharoptosis and Brow Lift

J05

L34528 — Blepharoplasty, Blepharoptosis and Brow Lift

J05

A57063 — Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy

J09

L33583 — Diagnostic and Therapeutic Esophagogastroduodenoscopy

J09

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