Does I85.10 require prior authorization?

No, I85.10 does not require prior authorization (high confidence). Covered without prior authorization.

`I85.10`, Secondary esophageal varices without 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.
The patient's medical record must include the ordering provider's assessment related to the complaint, relevant medical history, results of pertinent tests/procedures, and a signed and dated office visit record or operative report.
For services requiring a referring/ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.

Capsule endoscopy (CPT 91110, 91111 global) is payable under Medicare Part B when performed in office (POS 11), independent diagnostic testing facility (POS 49), or independent clinic (POS 49).
Technical component codes 91110-TC and 91111-TC are payable under Part B in office (11), IDTF (49), independent clinic (49), federally qualified health center (50), and rural health clinic (72).
Professional component codes 91110-26 and 91111-26 are payable under Part B in office (11), outpatient hospital (19 and 22), inpatient hospital (21), independent clinic (49), and public health clinic (71).
When capsule endoscopy is normal but compelling symptoms persist, irritable bowel syndrome or abdominal pain diagnosis codes K58.0, K58.9, R10.11-R10.13, R10.2, R10.31-R10.33, or R10.84 are on the list of covered diagnoses and may be used.
Report Patency Capsule Testing using CPT 91299 and enter 'Patency Capsule Testing' in Item 19 of the CMS-1500 (or electronic equivalent); the ingestion of the capsule is part of the test.
Telemetric gastrointestinal capsule imaging includes a technical component (capsule provision, hookup, downloading/processing) and a professional component (image review and interpretation with report); report the technical component's place of service as the location where the image download to the computer is performed.

CGS-J15-L34081, Endoscopy by Capsule

J15

CGS-J18-L34081, Endoscopy by Capsule

J18

A57063, Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy

FIRST_COAST-L33583, Diagnostic and Therapeutic Esophagogastroduodenoscopy

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