Does K59.00 require prior authorization?

No, K59.00 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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`K59.00`, Constipation, 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 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.
All services ordered or rendered must be signed and dated in the medical record, including a signed and dated office visit record or operative report.
An Advance Beneficiary Notice (ABN), Form CMS-R-131, should be signed by the beneficiary when applicable to indicate acceptance of financial responsibility.
The patient's medical record must include the ordering provider's assessment as it relates to the patient's complaint for that visit.

Key Coverage Criteria

Colonoscopy/sigmoidoscopy/proctosigmoidoscopy is covered for surveillance of colonic neoplasia in patients with a history of colorectal cancer or colonic polyps.
A follow-up procedure is covered 1 year after surgery for treatment of colorectal cancer when the patient is identified as high-risk for colon cancer and is eligible for continued screenings.
Plantar Fasciitis
Peptic Ulcer
Post-Operative Ileus
Post-Prandial Distress Syndrome

14 Active Policies

CGS-J15-L34005, Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy

J15

CGS-J18-L34005, Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy

J18

ANTHEM-CG-MED-97, Biofeedback and Neurofeedback

AETNA-CPB-0135, Acupuncture and Dry Needling

AETNA-CPB-0396, Gastrointestinal Function: Selected Tests

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K59.00, Constipation, unspecified