Does E06.1 require prior authorization?

No, E06.1 does not require prior authorization (high confidence). Covered without prior authorization.

`E06.1`, Subacute thyroiditis

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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).
The documentation 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 use of the selected ICD-10-CM code(s).

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.
Use ICD-10 codes T39.4X5A–T39.4X5S for ESR billing when the patient with rheumatoid arthritis is receiving antirheumatics such as gold salts for medication evaluation.

FIRST_COAST-L34021, Sedimentation Rate, Erythrocyte

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

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

A57657, Billing and Coding: Sedimentation Rate, Erythrocyte

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