Does T84.099S require prior authorization?

No, T84.099S does not require prior authorization (high confidence). Code is covered without prior authorization.

`T84.099S` — Other mechanical complication of unspecified internal joint prosthesis, sequela

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 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.
The submitted medical record must support the use of the selected ICD-10-CM code(s).

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.
Beneficiary is confined to the home to qualify for the Medicare home health PPS benefit.
Beneficiary is under the care of a physician.
Beneficiary is receiving services under a plan of care that is established and periodically reviewed by a physician.
Beneficiary needs skilled nursing care on an intermittent basis, or physical therapy, or speech-language pathology, or has a continued need for occupational therapy.
Physical therapy services ordered by a physician and provided by a qualified physical therapist or under the general supervision of a qualified physical therapist are covered when reasonable and necessary to treat illness/injury or to restore or maintain function.

A56796 — Billing and Coding: Lower Extremity Major Joint Replacement (Hip and Knee)

J12

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

J12

A57311 — Billing and Coding: Physical Therapy - Home Health

L33942 — Physical Therapy - Home Health

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