Does H68.021 require prior authorization?

No, H68.021 does not require prior authorization (high confidence). Code is covered without prior authorization.

`H68.021`, Chronic Eustachian salpingitis, right ear

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Supportive documentation evidencing the condition and treatment must be documented in the medical record and be available to the Contractor upon request.
ICD-10-CM diagnosis codes supporting the medical necessity of the service must be submitted with each claim.
High-utilization or repeat testing should include clinical justification in the record (for example, repeat testing due to unsatisfactory response to treatment) to support medical necessity.
Medical records must include history and physical notes, laboratory results, and documentation of signs and symptoms that warrant the head/neck diagnostic imaging.

Allergy testing for inhalant allergens is covered when medically necessary; evaluation may include up to 90 prick-puncture tests followed by up to 40 intracutaneous tests if prick/puncture results are negative.
Allergy testing for food sensitivity is covered when medically necessary and may require up to 40 percutaneous tests.
Multitest intracutaneous testing of up to 60 tests may be appropriate in lieu of prick-puncture testing for selected patients (for example, young children, older adults, or needle-phobic individuals).
Exceeding the stated testing parameters may be covered when preliminary testing failed and immunotherapy failed to control symptoms, provided documentation supports medical necessity.
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.

A57473, Billing and Coding: Allergy Testing

WPS-J5-L36402, Allergy Testing

WPS-J8-L36402, Allergy Testing

NOVITAS-JH-L35007, Vestibular and Audiologic Function Studies

NOVITAS-JL-L35007, Vestibular and Audiologic Function Studies

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