Does T84.011A require prior authorization?

No, T84.011A does not require prior authorization (high confidence). Code is covered without prior authorization.

`T84.011A` — Broken internal left hip prosthesis, initial encounter

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Claims and coding must follow and reference the Local Coverage Determination L33456; consult L33456 for specific clinical coverage criteria and required documentation.
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.
Initial lumbar MRI is covered when the test is medically reasonable and necessary and the medical record documents clinical rationale and supports the ICD-10-CM code(s) billed.
A second lumbar MRI for the same patient is allowable when documentation shows comparative test results are needed to make a more definitive treatment decision.
Multiple scans of different body areas performed on the same day for the same patient are payable when each scan is reasonable and necessary.
T82.535S | Leakage of umbrella device, sequela
M84.38XP | Stress fracture, other site, subsequent encounter for fracture with malunion

L39911 — Total Joint Arthroplasty

J05

A59811 — Billing and Coding: Total Joint Arthroplasty

J05

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

J09

L33618 — 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.