Does S35.513A require prior authorization?

No, S35.513A does not require prior authorization (high confidence). Code is covered without prior authorization.

`S35.513A` — Injury of unspecified iliac artery, initial encounter

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
Every page of the record must be legible and include appropriate patient identification information (for example, full name and dates of service).
The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
The submitted medical record must support the use of the selected ICD-10-CM code(s).

Magnetic resonance angiography (MRA) is covered only when the service meets the reasonable and necessary coverage criteria specified in Local Coverage Determination L34865.
Duplex scanning is covered only when it meets the reasonable and necessary requirements specified in Local Coverage Determination L33674.
Duplex scanning is covered to evaluate suspected chronic intestinal ischemia in patients with postprandial epigastric or periumbilical pain lasting 1–3 hours and associated weight loss from decreased oral intake.
Duplex scanning is covered to evaluate suspected acute intestinal ischemia in patients with acute crampy or steady epigastric/periumbilical pain with minimal abdominal exam findings and leukocytosis.
Duplex scanning is covered to evaluate possible injury to arterial inflow or venous outflow of abdominal, pelvic and/or retroperitoneal organs after trauma to those regions.
Duplex scanning is covered to evaluate suspected aneurysm of the renal artery or another visceral artery based on signs/symptoms or incidental radiologic finding.

A57636 — Billing and Coding: Duplex Scanning

J09

L33674 — Duplex Scanning

J09

A56805 — Billing and Coding: Magnetic Resonance Angiography (MRA)

J12

L34865 — Magnetic Resonance Angiography (MRA)

J12

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