Does K64.8 require prior authorization?

No, K64.8 does not require prior authorization (high confidence). Code is covered without prior authorization.

`K64.8`, Other hemorrhoids

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

When performed for surveillance of colonic neoplasia, report the appropriate CPT/HCPCS procedure code and the appropriate primary ICD-10-CM code plus one of the following secondary diagnosis codes: Z85.038, Z85.048, Z86.0100, Z86.0101, Z86.0102, or Z86.0109.
For high-risk post-surgical follow-up at 1 year (with continued 24-month screening eligibility), report HCPCS code G0105 as the appropriate screening/high-risk colonoscopy code.
Supportive clinical documentation evidencing the condition and treatment must be in the clinical notes or procedure note and made available upon request to the MAC or other authorized CMS auditor.
Medical records need not be submitted with the claim unless modifier -22 is used, but must be furnished to Medicare upon request and must support medical reasonableness, necessity, frequency, and substantiate the diagnosis listed on the claim.

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.
A colonoscopy may be billed when a sigmoidoscope is used only if the bowel is sufficiently short that the entire colon can be examined and this fact is clearly documented in the clinical record.
An incomplete colonoscopy (inability to advance the colonoscope to the cecum or colon‑small intestine anastomosis due to unforeseen circumstances) is billed using codes 44388, 45378, G0105 or G0121 with modifier -53.
When the colonoscopy procedure is unusual or difficult, report modifier -22 (unusual procedural services) on the claim.
A follow-on screening colonoscopy after a Medicare-covered non-invasive stool-based CRC screening test that is positive is included in a Complete Colorectal Cancer (CRC) Screening and should be billed as such with modifier -KX to confirm clinical requirements are met.

A56632, Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy

A57342, Billing and Coding: Diagnostic and Therapeutic Colonoscopy

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