Does I85.01 require prior authorization?

No, I85.01 does not require prior authorization (high confidence). Covered without prior authorization.

`I85.01`, Esophageal varices with bleeding

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

This billing and coding guidance complements Local Coverage Determination L34434; follow LCD L34434 for clinical coverage criteria and required documentation for claims.
All services billed with unlisted procedure codes must include sufficient medical records and supporting documentation to allow development and medical review.
For CID codes (T38.895*/T43.215*/T43.225*/T50.995*), the medical record must document the specific chemotherapy agent(s) causing the diarrhea and prior antidiarrheal treatments that have been ineffective.
For VIPoma diagnosis codes (C25.4, C26.0, D13.7, D13.91, D13.99), the medical record must document that the patient’s diagnosis is VIPoma.

Octreotide is covered for chemotherapy-induced diarrhea (CID) when claim includes ICD-10-CM codes T38.895A/T38.895D/T38.895S, T43.215A/T43.215D/T43.215S, T43.225A/T43.225D/T43.225S, or T50.995A/T50.995D/T50.995S and the medical record documents the chemotherapy agent(s) causing the CID and prior antidiarrheal treatments that became ineffective.
Octreotide is covered for treatment of VIPoma when claim includes ICD-10-CM codes C25.4, C26.0, D13.7, D13.91, or D13.99 and the medical record documents that the patient’s diagnosis is VIPoma.
Octreotide may be considered when ICD-10-CM code R79.89 is submitted if the medical record documents abnormal clinical or laboratory findings that led to suspicion of VIPoma.
Octreotide may be considered when ICD-10-CM code R94.7 is submitted if the medical record documents an abnormal octreotide scan that led to suspicion of VIPoma.
Non-invasive vascular diagnostic tests are covered when ordered by the treating practitioner or a consulting physician who will use the results to manage the beneficiary's specific medical problem.
A documented referral/order must be on record for each individual non-invasive vascular study performed for coverage to apply.

CGS-J15-L34084, Transcatheter Infusion Therapy

J15

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J18-L34045, Non-Invasive Vascular Studies

J18

CGS-J18-L34084, Transcatheter Infusion Therapy

J18

A56758

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