Does K31.9 require prior authorization?

No, K31.9 does not require prior authorization (high confidence). Covered without prior authorization.

`K31.9`, Disease of stomach and duodenum, unspecified

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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.
Providers must follow the billing, coding, and documentation requirements referenced in LCD L33455; this article provides supplementary coding guidance only.
Symptom logging requirement: use of a "validated symptom-logging App" during BSGM/Gastric Alimetry testing.
Reference to normative ranges and metrics: results should be "referenced to normative ranges" and interpreted using BSGM spectral metrics (e.g., Principal Gastric Frequency, GA Rhythm Index, BMI-adjusted amplitude, fed:fasted amplitude ratio).

Coverage and medical necessity for wireless gastrointestinal motility monitoring systems are determined according to Local Coverage Determination L33455.
Colon motility (manometric) study, minimum 6 hours continuous recording (CPT 91117) — covered if selection criteria are met.
CPT 78264 Gastric emptying imaging study (eg, solid, liquid, or both) — covered if selection criteria are met.
Use of colonic motility studies (colonic manometry) to guide decision-making for surgery in children with refractory colonic motility / defecatory disorders.
Radionuclide gastric emptying study for the evaluation of gastrointestinal motility disorders, and gastroparesis.
Magnetic resonance enterography to evaluate and monitor Crohn's disease and other small bowel disorders.

ANTHEM-CG-LAB-21, Serum Iron Testing

AETNA-CPB-0396, Gastrointestinal Function: Selected Tests

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

A56724, Billing and Coding: Wireless Gastrointestinal Motility Monitoring Systems

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