Does S85.111A require prior authorization?

No, S85.111A does not require prior authorization (high confidence). Code is covered without prior authorization.

`S85.111A` — Laceration of unspecified tibial artery, right leg, initial encounter

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

The ordering/referring practitioner's assessment related to the patient's complaint and the specific reason for the test must be documented in the medical record.
The medical record must contain a referral/order on file for each non‑invasive vascular study performed.
Results of pertinent tests and procedures performed that relate to the indication must be included in the medical record and reported on the claim if known; otherwise report the symptoms that prompted the test.
Signed and dated office visit notes and operative reports must be present in the record for the services ordered or rendered to Medicare beneficiaries.

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.
Cerebrovascular arterial duplex follow-up is covered annually for stenosis 20–49% (diameter reduction).
Cerebrovascular arterial duplex follow-up is covered every six months for stenosis 50–79% (diameter reduction).
Cerebrovascular arterial duplex follow-up is covered every six months for stenosis 80–99% if surgical correction has not been performed.
After carotid endarterectomy, repeat ipsilateral (unilateral) duplex examinations are allowable at approximately six weeks, six months, and one year post‑procedure during the first year.

A56758 — Billing and Coding: Non-Invasive Vascular Studies

J06

L33627 — Non-Invasive Vascular Studies

J06

A57064 — Billing and Coding: Duplex Scan of Lower Extremity Arteries

J09

L33667 — Duplex Scan Of Lower Extremity Arteries

J09

L34045 — Non-Invasive Vascular Studies

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