Does E87.20 require prior authorization?

No, E87.20 does not require prior authorization (high confidence). Covered without prior authorization.

`E87.20`, Acidosis, unspecified

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

For services that require a referring/ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.
The claim must include a valid ICD-10-CM diagnosis code that best describes the patient's condition for which the urine drug test was performed.
For diagnostic urine drug tests, report the test result if known; if the result is not known, report the symptoms that prompted the performance of the test.
This billing and coding guidance complements Local Coverage Determination L35724 and providers should follow LCD L35724 in conjunction with NCCI/OPPS rules when preparing claims.

Each dialysis session performed for an ESRD patient must be reported on a separate line for dates of service on or after 2007-04-01.
When the hemodialysis prescription is three times per week and each session is furnished, bill each session as CPT 90999 with no modifier; these sessions will be paid as routine conventional dialysis.
Dialysis sessions furnished in addition to three per week that have medical documentation supporting reasonable and necessary need should be billed as CPT 90999 with the KX modifier for consideration of additional payment.
Report each hemodialysis session for ESRD patients on a separate line for claims with dates of service on or after April 1, 2007.
When hemodialysis prescription is 3 sessions per week and each session is furnished, bill each session as CPT 90999 with no modifier for routine conventional dialysis.
For dialysis sessions beyond 3 sessions per week that are reasonable and necessary and supported by medical documentation, bill each additional session as CPT 90999 with modifier KX to be considered for additional payment.

CGS-J15-L37575, Frequency of Hemodialysis

J15

CGS-J15-L36029, Urine Drug Testing

J15

CGS-J18-L36029, Urine Drug Testing

J18

CGS-J18-L37575, Frequency of Hemodialysis

J18

A55703, Billing and Coding: Frequency of Hemodialysis

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