Does K28.9 require prior authorization?

No, K28.9 does not require prior authorization (high confidence). Covered without prior authorization.

`K28.9`, Gastrojejunal ulcer, unspecified as acute or chronic, without hemorrhage or perforation

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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 and coding article provides guidelines that complement Local Coverage Determination L34415 for CT of the abdomen and pelvis; consult LCD L34415 for specific coverage indications, limitations, and documentation requirements.

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.
Acanthamoeba in corneal ulceration
Actinomyces, for identification of actinomyces species in tissue specimens
Adenovirus, to diagnose adenovirus myocarditis, and to diagnose adenovirus infection in immunocompromised hosts, including transplant recipients
Anaplastic lymphoma kinase (ALK) testing as an alternative to FISH for selecting individuals for ALK inhibitor therapy

FIRST_COAST-L33583, Diagnostic and Therapeutic Esophagogastroduodenoscopy

A57063, Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy

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

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

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

AETNA-CPB-0650, Polymerase Chain Reaction Testing: Selected Indications

ANTHEM-CG-LAB-21, Serum Iron Testing

A56389, Billing and Coding: Upper Gastrointestinal Endoscopy and Visualization

A56421, Billing and Coding: CT of the Abdomen and Pelvis