Does E03.4 require prior authorization?

No, E03.4 does not require prior authorization (high confidence). Covered without prior authorization.

`E03.4`, Atrophy of thyroid (acquired)

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

This billing/coding guideline complements LCD L33459 (Computerized Axial Tomography (CT), Thorax); follow the LCD for clinical coverage and any required documentation or prior authorization rules.
Billing and coding guidance in this policy complements and references Local Coverage Determination L34425; claims should be supported per the documentation requirements specified in LCD L34425.
All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
Every page of the medical record must be legible and include appropriate patient identification (e.g., complete name and dates of service).

No specific clinical indications are listed in this billing/coding guidance; coverage determinations for MRI of the head and neck follow Local Coverage Determination L34425.
Ultrasound of soft tissues of the head and neck is covered when it is reasonable and necessary as defined by Local Coverage Determination L34027.
CT or MRI scans of the head or neck are covered when the medical record documents the scan is reasonable and necessary for diagnostic evaluation.
Coverage requires documentation supporting clinical indication such as history and physical exam findings, laboratory results, and signs or symptoms that justify the diagnostic test.
Erythrocyte sedimentation rate (ESR) testing is covered only when reasonable and necessary as defined by Local Coverage Determination L34021.
ESR performed for rheumatoid arthritis patients to assess the need for medication adjustments should be billed with a diagnosis code that reflects the specific antirheumatic medication the patient is receiving.

A57029, Billing and Coding: Ultrasound, Soft Tissues of Head and Neck

FIRST_COAST-L34027, Ultrasound, Soft Tissues of Head and Neck

A57657, Billing and Coding: Sedimentation Rate, Erythrocyte

FIRST_COAST-L34021, Sedimentation Rate, Erythrocyte

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