Does S32.401B require prior authorization?

No, S32.401B does not require prior authorization (high confidence). Code is covered without prior authorization.

`S32.401B` — Unspecified fracture of right acetabulum, initial encounter for open fracture

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

This billing and coding article provides guidelines that complement Local Coverage Determination L34415 for CT of the abdomen and pelvis; consult LCD L34415 for specific coverage indications, limitations, and documentation requirements.
All documentation must be maintained in the patient’s medical record and made available to the contractor upon request.
Every page of the medical record must be legible and include appropriate patient identification information such as complete name and dates of service.
The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the patient’s care.

Coverage for lower extremity major joint replacement (hip and knee) is subject to the reasonable and necessary requirements of Local Coverage Determination L36007; services meeting LCD L36007 criteria are covered.
Total hip arthroplasty (THA) is covered for advanced hip joint disease when hip arthritis is documented by X-ray, MRI, or CT demonstrating one or more of: subchondral cysts, subchondral sclerosis, periarticular osteophytes, joint subluxation, degree of joint space narrowing, avascular necrosis, or bone-on-bone articulation.
THA is covered when the patient has hip pain or functional disability documented in context (e.g., pain interfering with ADLs, pain increased with initiation of activity, or pain increased with weight bearing).
THA is covered when documentation shows unsuccessful conservative (non-surgical) therapy as appropriate for the current episode (e.g., documented trial of NSAIDs or supervised physical therapy, or documented contraindication to such therapy).
THA is covered for joint malignancy when supporting evidence is in the record (e.g., pathology report and oncologist referral) demonstrating malignancy of the joint.
THA or revision/replacement is covered for acute or chronic fracture when imaging (e.g., X-ray) documents the fracture and justifies the procedure.

A59811 — Billing and Coding: Total Joint Arthroplasty

J05

L39911 — Total Joint Arthroplasty

J05

L33618 — Major Joint Replacement (Hip and Knee)

J09

A57765 — Billing and Coding: Major Joint Replacement (Hip and Knee)

J09

L36007 — Lower Extremity Major Joint Replacement (Hip and Knee)

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