Does J34.9 require prior authorization?

No, J34.9 does not require prior authorization (high confidence). Covered without prior authorization.

`J34.9`, Unspecified disorder of nose and nasal sinuses

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

This policy provides billing, coding, and guideline information that complements the Local Coverage Determination (LCD) 'Cosmetic and Reconstructive Surgery' L33428; the full policy content is not included here, so specific documentation requirements (e.g., medical records, prior authorizations, forms) are not available in the provided excerpt.
If treating epistaxis: identification/documentation of the known or suspected bleeding site when purpose of surgery is control of epistaxis.
If treating sinus disease: identification/documentation of the sinus that is recurrently infected when the purpose of surgery is to control disease.
When symptoms are present with septal deviation: diagram/description noting position and degree of deviations, dislocations, and spurs on the septum.

Prolonged, persistent obstructed nasal breathing;
Physical examination confirming moderate to severe vestibular obstruction;
Airway obstruction will not respond to septoplasty and turbinectomy alone;
Nasal airway obstruction is causing significant symptoms (e.g., chronic rhinosinusitis, difficulty breathing);
Obstructive symptoms persist despite conservative management for 4 weeks or greater, which includes, where appropriate, nasal steroids or immunotherapy;
Photographs demonstrate an external nasal deformity;

ANTHEM-CG-SURG-73, Balloon Sinus Ostial Dilation

AETNA-CPB-0005, Septoplasty and Rhinoplasty

AETNA-CPB-0592, Intranasal Ablation

A56658, Billing and Coding: Cosmetic and Reconstructive Surgery

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