Does T85.692A require prior authorization?

No, T85.692A does not require prior authorization (high confidence). Code is covered without prior authorization.

`T85.692A` — Other mechanical complication of permanent sutures, initial encounter

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Claims for covered bariatric surgery must include three diagnosis codes with the primary diagnosis as E66.01, E66.812, or E66.813 and secondary/tertiary diagnoses from the specified ICD-10-CM code groups (group 1 and group 2).
When using CPT 43843 or CPT 43999 to bill a Not Otherwise Classified (NOC) or specific open procedures, include a note identifying the specific test/procedure performed in the Remarks area for Part A claims and the Narrative area for Part B claims.
Refer to LCD L35022 for complete reasonable-and-necessary documentation requirements and retain supporting medical records as required by Medicare policy.
Medical records must include history and physical notes, laboratory results, and documentation of signs and symptoms that warrant the head/neck diagnostic imaging.

Coverage for selected bariatric surgical procedures is allowed only for patients who meet the national and local reasonable-and-necessary criteria set forth in LCD L35022.
Claims for covered bariatric procedures must report three diagnoses: a primary diagnosis of morbid obesity (one of E66.01, E66.812, or E66.813), a secondary diagnosis from ICD-10-CM Code group 1, and a tertiary diagnosis from ICD-10-CM Code group 2.
Use CPT 43659 when both the gastric band and the subcutaneous port components were removed and replaced in the same encounter.
CT or MRI scans of the head or neck are covered when the medical record documents the scan is reasonable and necessary for diagnostic evaluation.
Coverage requires documentation supporting clinical indication such as history and physical exam findings, laboratory results, and signs or symptoms that justify the diagnostic test.
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.

L35022 — Bariatric Surgical Management of Morbid Obesity

J12

A56422 — Billing and Coding: Bariatric Surgical Management of Morbid Obesity

J12

A57204 — Billing and Coding: MRI and CT Scans of the Head and Neck

A57206 — Billing and Coding: Lumbar MRI

L34220 — Lumbar MRI

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