Does E84.11 require prior authorization?

No, E84.11 does not require prior authorization (high confidence). Covered without prior authorization.

`E84.11`, Meconium ileus in cystic fibrosis

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.
The patient's medical record must include the ordering provider's assessment as it relates to the patient's complaint for that visit.
Medical records must include relevant medical history and results of pertinent tests/procedures that justify the Vitamin D assay.
All services ordered or rendered to Medicare beneficiaries must be signed and dated; include signed and dated office visit records or operative reports in the record.

Vitamin D assay testing billed to Medicare Part A or Part B MAC is covered when ordered by an authorized provider (physician or state-authorized non-physician) and the service is otherwise consistent with local coverage determination L33996.
A valid ICD-10-CM diagnosis code that best describes the patient's condition prompting the Vitamin D assay must be reported on the claim; for diagnostic tests, report the test result if known, otherwise report the presenting symptoms.
When a referring/ordering provider is required, the referring/ordering provider name and NPI must be reported on the claim.
Therapeutic respiratory procedures (HCPCS G0237, G0238, G0239) using an individualized physical conditioning and exercise program with breathing techniques are covered for patients with documented activity limitations.
Pulmonary function tests (PFTs) represented by CPT codes 94070, 94200, 94640, 94726, 94727, and 94729 are covered when reasonable and medically necessary with supporting clinical documentation and a written order by a physician or appropriate NPP.
Spirometry (CPT 94010, 94011, 94012, 94060, 94070, 94150, 94200, 94375, 94726, 94727) is covered when clinically indicated and documented in the medical record.

CGS-J15-L33996, Vitamin D Assay Testing

J15

CGS-J18-L33996, Vitamin D Assay Testing

J18

WPS-J5-L34658, Vitamin D Assay Testing

A57484, Billing and Coding: Vitamin D Assay Testing

NGS-J6-L37535, Vitamin D Assay Testing

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