Does D24.9 require prior authorization?

No, D24.9 does not require prior authorization (high confidence). Covered without prior authorization.

`D24.9`, Benign neoplasm of unspecified breast

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Maintain all documentation in the patient's medical record and make it available to the contractor upon request; every page must be legible and include patient identifiers (complete name, dates of service).
Medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
Documentation should state whether the block was performed for diagnostic or therapeutic purposes.

Peripheral nerve blocks are covered when they meet the reasonable and necessary requirements specified in LCD L33933.
None specified. Aetna considers the analysis of volatile organic compounds experimental and investigational for the indications listed below (see Limitations).
Minimally invasive image-guided breast biopsy procedures are medically necessary as alternatives to needle localization core surgical biopsy (NLBx) in members with abnormalities identified by mammography that are non-palpable or difficult to palpate (e.g., deep, mobile, small [< 2 cm], or composed of clustered microcalcifications).
Advanced Breast Biopsy Instrument (ABBI) for non-palpable or difficult-to-palpate mammographically-identified breast abnormalities.
MRI-guided core-needle biopsy for non-palpable or difficult-to-palpate mammographically-identified breast abnormalities.
19286 each additional lesion, including ultrasound guidance (List separately in addition to code for primary procedure)

FIRST_COAST-L33933, Peripheral Nerve Blocks

AETNA-CPB-0100, Cryoablation

AETNA-CPB-0105, Magnetic Resonance Imaging (MRI) of the Breast

AETNA-CPB-0269, Breast Biopsy Procedures

AETNA-CPB-0337, BreastCare/BreastAlert Differential Temperature Sensor

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