Does E07.0 require prior authorization?

No, E07.0 does not require prior authorization (high confidence). Covered without prior authorization.

`E07.0`, Hypersecretion of calcitonin

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.
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.

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.
ICD-10 diagnosis listed as covered if selection criteria are met: E07.0 (Hypersecretion of calcitonin).
ICD-10 diagnosis listed as covered if selection criteria are met: Q43.1 (Hirschsprung's disease).
Tests for germline point mutations in the RET gene medically necessary for members who meet any of the following high-risk criteria:

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

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

AETNA-CPB-0319, RET Proto-Oncogene Testing

A56580, Billing and Coding: Computerized Axial Tomography (CT), Thorax

A57204, Billing and Coding: MRI and CT Scans of the Head and Neck

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