Does B95.1 require prior authorization?

No, B95.1 does not require prior authorization (high confidence). Covered without prior authorization.

`B95.1`, Streptococcus, group B, as the cause of diseases classified elsewhere

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

The medical record must document the medical reasonableness, necessity, and clinical frequency of the diagnostic colonoscopy or sigmoidoscopy and be available to the Contractor upon request.
Documentation must indicate the precise areas scoped and the depth reached during colonoscopy.
Refer to associated LCD L34614 and Medicare IOM for additional coverage and documentation guidance for colorectal cancer screening procedures.
For reduction mammoplasty, the medical record must include height and weight of the beneficiary.

Diagnostic colonoscopy or sigmoidoscopy is covered to directly visualize the lower gastrointestinal tract (colon, rectum, sigmoid) to detect polyps, tumors, or other intestinal lesions.
Diagnostic colonoscopy is covered when identification of the site of pathology and/or obtaining a biopsy during the procedure is clinically indicated.
A follow-on screening colonoscopy is covered after a positive covered blood-based biomarker noninvasive colorectal cancer (CRC) screening test per NCD 210.3, effective 2025-01-01.
Reconstructive plastic surgery is covered when performed for therapeutic purposes such as treatment of severe burns, facial repair following auto trauma, or similar reconstructive/therapeutic surgery.
Reduction mammoplasty is covered when the beneficiary has symptomatic breast hypertrophy (macromastia) with documented severe symptoms and demonstrable adverse impact on health-related quality of life as measured by an accepted breast-specific questionnaire, AND persistent signs/symptoms despite a reasonable trial of conservative therapy.
Acanthamoeba in corneal ulceration

WPS-J5-L34614, Colonoscopy and Sigmoidoscopy-Diagnostic

A56394, Billing and Coding: Colonoscopy and Sigmoidoscopy-Diagnostic

WPS-J8-L34614, Colonoscopy and Sigmoidoscopy-Diagnostic

ANTHEM-CG-MED-68, Therapeutic Apheresis

AETNA-CPB-0650, Polymerase Chain Reaction Testing: Selected Indications

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