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ICD-10-CM K03.89, Other specified diseases of hard tissues of teeth | No Prior Auth

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`K03.89`, Other specified diseases of hard tissues of teeth

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

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

Key Coverage 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.)

1 Active Policy

AETNA-CPB-0302, Xerostomia: Selected Treatments

Related Codes

15773(1 policies)15774(1 policies)97810(1 policies)97814(1 policies)99183(1 policies)E0755(1 policies)G0277(1 policies)15769(1 policies)

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