Does D15.9 require prior authorization?

No, D15.9 does not require prior authorization (high confidence). Code is covered without prior authorization.

`D15.9`, Benign neoplasm of intrathoracic organ, unspecified

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

The performing provider must maintain medical record documentation that clearly supports the medical necessity of the billed service and include that documentation in the patient's record for review upon request.
Documentation should state whether the block was diagnostic or therapeutic, include pre- and post-procedure evaluations, and document patient education and the assessment of procedural outcome.
Documentation must support coverage criteria in the LCD 'Indications and Limitations of Coverage and/or Medical Necessity' section and the provider should document why services cannot be rendered by the surgeon when applicable.
For services requiring a referring/ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.

CPT codes 64400-64530 for peripheral nerve blocks may be reported on the date of surgery when performed for postoperative pain management only if the operative anesthesia is general anesthesia, subarachnoid injection, or epidural injection and the adequacy of intraoperative anesthesia is not dependent on the peripheral nerve block.
Peripheral nerve block services that are separate, medically necessary services which cannot be rendered by the surgeon may be reported if the surgeon documents the reason for referral and the additional services are justified in the medical record.
Peripheral nerve blocks are covered when they meet the reasonable and necessary requirements specified in LCD L33933.
Peripheral nerve blocks are covered for diagnostic purposes to isolate pain when a classic mononeuritis is suspected but neuro-diagnostic studies fail to show a structural explanation.
Peripheral nerve blocks are covered for treatment of complex regional pain syndrome (CRPS) resulting from peripheral nerve injuries, entrapment, or extremity trauma.
Occipital nerve blocks are covered to confirm the diagnosis of occipital neuralgia when the clinical picture is suggestive or unclear.

NGS-J6-L36850, Peripheral Nerve Blocks

A57452, Billing and Coding: Peripheral Nerve Blocks

FIRST_COAST-L33933, Peripheral Nerve Blocks

NGS-JK-L36850, Peripheral Nerve Blocks

A57788, Billing and Coding: Peripheral Nerve Blocks

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