Does D41.20 require prior authorization?

No, D41.20 does not require prior authorization (high confidence). Covered without prior authorization.

`D41.20`, Neoplasm of uncertain behavior of unspecified ureter

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.
ESAs are appropriate to treat symptomatic anemia of chronic kidney disease in patients on dialysis when billed using ESRD-specific HCPCS codes (J0882, J0887, Q4081, Q5105) and documented diagnoses D63.1 and N18.6.
Non-ESRD ESA therapy for anemia due to myelosuppressive anticancer chemotherapy is indicated when billed with HCPCS codes J0881, J0885, J0888 or Q5106 with modifier EA and when the most recent hemoglobin is < 10.0 g/dL or hematocrit is < 30.0%.
All ESA administrations (ESRD and non-ESRD) must be reported with one ESA-purpose modifier (EA, EB, or EC) and one route modifier (JA, JB, or JE) on the claim to be processed rather than returned.
ESA administration is permitted only when medical record documents justify reasonable and necessary use for the individual patient, including Hb/Hct values, blood pressure control, weight, assessment of other causes of anemia, dose and route.
Peripheral nerve block is reasonable when the patient's pain appears due to a classic mononeuritis but neuro-diagnostic studies fail to provide a structural explanation.

NGS-J6-L40333, Erythropoiesis Stimulating Agents

NGS-J6-L40334, Erythropoiesis Stimulating Agents

FIRST_COAST-L33933, Peripheral Nerve Blocks

NGS-JK-L40334, Erythropoiesis Stimulating Agents

NGS-JK-L40333

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