Does D44.10 require prior authorization?

No, D44.10 does not require prior authorization (high confidence). Covered without prior authorization.

`D44.10`, Neoplasm of uncertain behavior of unspecified adrenal gland

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

This article provides billing/coding guidelines that complement Local Coverage Determination L34417 for CT of the head; consult LCD L34417 for specific coverage, coding, and documentation requirements.
The patient's medical record must contain documentation that fully supports medical necessity for services included in the related LCD, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Include a treatment prescription that defines treatment goals and specific dose-volume parameters for the target and nearby critical structures, and details of beam delivery such as method of beam modulation, field arrangement, and expected positional and range uncertainties.
Include a physician-signed treatment plan that meets the prescribed dose-volume parameters for the clinical target volume (CTV) and surrounding organs at risk (OARs) accounting for expected uncertainties.

Proton beam therapy is covered when the service meets the medical necessity criteria specified in the related Local Coverage Determination (LCD) and those criteria are documented in the medical record.
Peripheral nerve blocks are covered when they meet the reasonable and necessary requirements specified in LCD L33933.
Evaluation of Coronary Artery Disease: PET scans using rubidium-82 (Rb-82) or N-13 ammonia done at rest or with pharmacological stress for non-invasive imaging of the perfusion of the heart for the diagnosis and management of members with known or suspected coronary artery disease when either (a) the PET scan is used in place of, but not in addition to, a single photon emission computed tomography (SPECT) in persons who meet medical necessity criteria for a cardiac SPECT (see CPB 0376) or (b) fo [...]
Absolute quantitation of myocardial blood flow (AQMBF) as a medically necessary adjunct to cardiac PET when criteria for rest/stress perfusion for coronary artery disease are met.
Assessment of Myocardial Viability: FDG-PET for the determination of myocardial viability prior to re-vascularization, either as a primary or initial diagnostic study or following an inconclusive SPECT.
Cardiac Sarcoid: FDG-PET to identify and monitor response to therapy for established or strongly suspected cardiac sarcoid.

A56827, Billing and Coding: Proton Beam Therapy

NGS-J6-L35075, Proton Beam Therapy

FIRST_COAST-L33933, Peripheral Nerve Blocks

NGS-JK-L35075, Proton Beam Therapy

AETNA-CPB-0071, Positron Emission Tomography (PET)

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