Does K55.062 require prior authorization?

No, K55.062 does not require prior authorization (high confidence). Covered without prior authorization.

`K55.062`, Diffuse acute infarction of intestine, part unspecified

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.
The medical record must document the medical reasonableness, necessity, and clinical frequency of the diagnostic colonoscopy or sigmoidoscopy and be available to the Contractor upon request.
Documentation must indicate the precise areas scoped and the depth reached during colonoscopy.

Diagnostic colonoscopy or sigmoidoscopy is covered to directly visualize the lower gastrointestinal tract (colon, rectum, sigmoid) to detect polyps, tumors, or other intestinal lesions.
Diagnostic colonoscopy is covered when identification of the site of pathology and/or obtaining a biopsy during the procedure is clinically indicated.
A follow-on screening colonoscopy is covered after a positive covered blood-based biomarker noninvasive colorectal cancer (CRC) screening test per NCD 210.3, effective 2025-01-01.
This article does not specify clinical indications; refer to LCD L36427 for covered indications for wireless capsule endoscopy.
MRA is covered to evaluate blood flow in the internal carotid vessels of the head and neck.
MRA of peripheral arteries of the lower extremities is covered to determine the presence and extent of peripheral vascular disease and may substitute for conventional angiography (CA).

A56394, Billing and Coding: Colonoscopy and Sigmoidoscopy-Diagnostic

A57591, Billing and Coding: Non-Invasive Abdominal / Visceral Vascular Studies

WPS-J5-L34614, Colonoscopy and Sigmoidoscopy-Diagnostic

WPS-J5-L35755, Non-Invasive Abdominal / Visceral Vascular Studies

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