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ICD-10-CM A42.9, Actinomycosis, unspecified | No Prior Auth

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`A42.9`, Actinomycosis, unspecified

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Key Coverage Criteria

Chronic sinusitis (for example, greater than 12 weeks duration) that interferes with lifestyle;and
Functional endoscopic sinus surgery (FESS) is consideredmedically necessarywhenany oneof the following circumstances is present:
Suspected tumor seen on imaging, physical examination, or endoscopy;or
Suppurative (pus forming) complications, including but are not limited to:Subperiosteal abscess;orBrain abscess;or
Subperiosteal abscess;or
Brain abscess;or

3 Active Policies

ANTHEM-CG-SURG-24, Functional Endoscopic Sinus Surgery (FESS)

ANTHEM-CG-MED-73, Hyperbaric Oxygen Therapy (Systemic/Topical)

ANTHEM-CG-LAB-29, Gamma Glutamyl Transferase Testing

Related Codes

A42.0(3 policies)E08.00(2 policies)A48.0(2 policies)B37.0(2 policies)B37.9(2 policies)E13.9(2 policies)31257(1 policies)31256(1 policies)

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