Does K02.9 require prior authorization?

No, K02.9 does not require prior authorization (high confidence). Covered without prior authorization.

`K02.9`, Dental caries, unspecified

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

None specified in the document. (The CPB does not provide explicit documentation requirements such as required medical records, test results, or prior authorization criteria.)

Xerostomia (dry mouth) — This Clinical Policy Bulletin addresses xerostomia: selected treatments. (No explicit "Covered Indications" section or explicit covered interventions are provided in the document.)
Use of moderate to deep anesthesia services in conjunction with the delivery of dental services in the facility setting is consideredmedicallynecessarywhen the following criteria have been met (AandB):
Extensive surgical procedures are required;and
Submitted documentation (including narrative, radiographs, etc.) demonstrates that the individual has a condition, medical comorbidity, or current medical status that requires a facility setting, including, but not limited to the following:The individual is currently hospitalized and requires dental care during the hospital stay;orThe individual is a child under 6 years of age;orThe risk of intraoperative complications is elevated, as indicated by assignment of American Society of Anesthesiologi [...]
The individual is currently hospitalized and requires dental care during the hospital stay;or
The individual is a child under 6 years of age;or

ANTHEM-CG-MED-41, Moderate to Deep Anesthesia Services for Dental Surgery in the Facility Setting

AETNA-CPB-0302, Xerostomia: Selected Treatments

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