Does H80.93 require prior authorization?

No, H80.93 does not require prior authorization (high confidence). Covered without prior authorization.

`H80.93`, Unspecified otosclerosis, bilateral

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.
Aetna considers aural rehabilitation (including auditory verbal therapy [AVT]) medically necessary as speech therapy for members with hearing impairments and after placement of a cochlear implant.
Auditory rehabilitation for members with cochlear implants (i.e., services after placement of a cochlear implant).
Auditory rehabilitation services described by CPT codes when selection criteria are met: 92626 (Evaluation of auditory rehabilitation status; first hour), 92627 (each additional 15 minutes), 92630 (Auditory rehabilitation; pre-lingual hearing loss), 92633 (Auditory rehabilitation; post-lingual hearing loss).
Related services/care in conjunction with cochlear device implantation (CPT 69930) and cochlear device/system/supplies (HCPCS L8614-L8624) when selection criteria are met.

AETNA-CPB-0034, Aural Rehabilitation

AETNA-CPB-0524, Zoledronic Acid

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.