Does K43.9 require prior authorization?

No, K43.9 does not require prior authorization (high confidence). Covered without prior authorization.

`K43.9`, Ventral hernia without obstruction or gangrene

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.
This policy provides billing, coding, and guideline information that complements the Local Coverage Determination (LCD) 'Cosmetic and Reconstructive Surgery' L33428; the full policy content is not included here, so specific documentation requirements (e.g., medical records, prior authorizations, forms) are not available in the provided excerpt.
If necrotic tissue with eschar is present, documentation that debridement was attempted (otherwise NPWT contraindicated).
Information describing the history, previous treatment regimens (if applicable), and current wound management for which an NPWT pump is being billed must be present in the member’s medical record and be available for review upon request.

Chronic Stage III or IV pressure ulcer present for at least 30 days when a complete wound therapy program (see general measures and Stage III/IV specific measures) has been tried or considered and ruled out prior to application of NPWT.
Neuropathic ulcer (e.g., diabetic ulcer) present for at least 30 days when a complete wound therapy program (see general measures and neuropathic-specific measures) has been tried or considered and ruled out prior to application of NPWT.
Venous insufficiency ulcer present for at least 30 days when a complete wound therapy program (see general measures and venous-specific measures) has been tried or considered and ruled out prior to application of NPWT.
Arterial insufficiency ulcer present for at least 30 days when a complete wound therapy program has been tried or considered and ruled out prior to application of NPWT.
Pressure ulcers
Use of negative pressure wound therapy to secure skin grafts (split-thickness skin grafts)

AETNA-CPB-0244, Skin and Soft Tissue Substitutes

AETNA-CPB-0334, Negative Pressure Wound Therapy

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

A56658, Billing and Coding: Cosmetic and Reconstructive Surgery

REGENCE-SUR12.03, Anterior Abdominal Wall (Including Incisional) Hernia Repair

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