Does K22.719 require prior authorization?

No, K22.719 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

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`K22.719`, Barrett's esophagus with dysplasia, unspecified

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Documentation Required

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.
This billing/coding guideline complements LCD L33459 (Computerized Axial Tomography (CT), Thorax); follow the LCD for clinical coverage and any required documentation or prior authorization rules.

Key Coverage Criteria

Esophagogastroduodenoscopy (EGD) is covered when it meets the reasonable and necessary requirements specified in Local Coverage Determination L33583.
Upper gastrointestinal endoscopy (diagnostic or therapeutic) is covered when determined reasonable and necessary per Local Coverage Determination L35350.
Radiofrequency ablation (RFA) is medically necessary for treatment of Barrett's esophagus (BE) when there is histological confirmation of low-grade dysplasia (LGD) by 2 or more endoscopies performed at least 3 months apart.
Endoscopic mucosal resection (EMR) is medically necessary for treatment of Barrett's esophagus with high-grade dysplasia (HGD) confirmed by biopsy.
Esophagectomy is medically necessary for treatment of Barrett's esophagus with high-grade dysplasia (HGD) confirmed by biopsy.
Fundoplication is medically necessary for treatment of Barrett's esophagus with high-grade dysplasia (HGD) confirmed by biopsy.

11 Active Policies

FIRST_COAST-L33583, Diagnostic and Therapeutic Esophagogastroduodenoscopy

A57063, Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy

NOVITAS-JH-L35350, Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)

NOVITAS-JL-L35350, Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)

A57414, Billing and Coding: Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)

A56580, Billing and Coding: Computerized Axial Tomography (CT), Thorax

AETNA-CPB-0667, Esophageal and Airway pH Monitoring

ANTHEM-CG-LAB-12, Testing for Oral and Esophageal Cancer

ANTHEM-CG-SURG-101, Ablative Techniques as a Treatment for Barrett’s Esophagus

AETNA-CPB-0728, Barrett's Esophagus

A56389, Billing and Coding: Upper Gastrointestinal Endoscopy and Visualization

`K22.719`, Barrett's esophagus with dysplasia, unspecified

Prior Authorization

Documentation Required

Key Coverage Criteria

11 Active Policies

Related Codes

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K22.719, Barrett's esophagus with dysplasia, unspecified

Prior Authorization

Documentation Required

Key Coverage Criteria

11 Active Policies

Related Codes

Have a follow-up question?

`K22.719`, Barrett's esophagus with dysplasia, unspecified