Does H80.20 require prior authorization?

No, H80.20 does not require prior authorization (high confidence). Covered without prior authorization.

`H80.20`, Cochlear otosclerosis, unspecified ear

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Medical records must include history and physical notes, laboratory results, and documentation of signs and symptoms that warrant the head/neck diagnostic imaging.
Accurate HCPCS/CPT coding must be submitted to differentiate CT and MRI scans from other radiology services and to support coverage determinations.
Documentation and supporting information must be available to Medicare upon request.
Providers should check and apply Correct Coding Initiative (CCI) edits and applicable LCD guidance for correct code combinations before billing.

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.
CPT codes covered if criteria are met: 92640 Diagnostic analysis with programming of auditory brainstem implant, per hour
HCPCS codes covered if selection criteria are met: S2235 Implantation of auditory brain stem implant
Persons with a unilateral cochlear implant may qualify for subsequent bilateral implantation without retesting if medical records document they met criteria at time of initial implantation.
Auditory brainstem implant (ABI) is medically necessary in members 12 years of age or older who have lost both auditory nerves due to disease (e.g., neurofibromatosis / von Recklinghausen's disease) or when bilateral surgical removal of auditory nerve tumors is planned and is expected to result in complete bilateral deafness.

AETNA-CPB-0013, Cochlear Implants and Auditory Brainstem Implants

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.