Does K11.1 require prior authorization?

No, K11.1 does not require prior authorization (high confidence). Covered without prior authorization.

`K11.1`, Hypertrophy of salivary gland

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Medical records must include history and physical notes, laboratory results, and documentation of signs and symptoms that warrant the head/neck diagnostic imaging.
Accurate HCPCS/CPT coding must be submitted to differentiate CT and MRI scans from other radiology services and to support coverage determinations.
Documentation and supporting information must be available to Medicare upon request.
Providers should check and apply Correct Coding Initiative (CCI) edits and applicable LCD guidance for correct code combinations before billing.

CT or MRI scans of the head or neck are covered when the medical record documents the scan is reasonable and necessary for diagnostic evaluation.
Coverage requires documentation supporting clinical indication such as history and physical exam findings, laboratory results, and signs or symptoms that justify the diagnostic test.
The following surgical procedures to control excessive drooling may be considered medically necessary for members who meet the selection criteria listed above: Parotid duct diversion, bilateral, with excision of one submandibular gland.
The following surgical procedures to control excessive drooling may be considered medically necessary for members who meet the selection criteria listed above: Parotid duct diversion, bilateral, with excision of both submandibular glands.
The following surgical procedures to control excessive drooling may be considered medically necessary for members who meet the selection criteria listed above: Parotid duct diversion, bilateral, with ligation of both submandibular ducts.
The following surgical procedures to control excessive drooling may be considered medically necessary for members who meet the selection criteria listed above: Relocation of the submandibular ducts, with or without removal of sublingual glands.

AETNA-CPB-0265, Treatments to Control Drooling (Sialorrhea)

A57204, Billing and Coding: MRI and CT Scans of the Head and Neck

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