Does K73.9 require prior authorization?

No, K73.9 does not require prior authorization (high confidence). Covered without prior authorization.

`K73.9`, Chronic hepatitis, unspecified

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Verify and document compliance with applicable NCCI edits and OPPS packaging rules prior to billing.
Include a valid ICD-10-CM diagnosis code on the claim that best describes the patient's condition for which the heavy metal test was performed.
For diagnostic heavy metal tests, report the test result on the claim if known; if the result is not known, report the symptoms that prompted the test.
When required, report the referring/ordering physician's name and NPI on the claim.

Esophagogastroduodenoscopy (EGD) is covered when it meets the reasonable and necessary requirements specified in Local Coverage Determination L33583.
Monitored Anesthesia Care (MAC) is medically necessary when the patient has one or more documented diagnoses listed as supporting medical necessity (e.g., F91.9, G97.81, T81.9XXA, T88.8XXA, F79) and the diagnosis is matched to the anesthesia/CPT/HCPCS procedure performed.
Use G9 anesthesia modifier to indicate need for MAC due to a history of severe or advanced cardiopulmonary disease when the proceduralist determines additional monitoring is required.
Use G8 anesthesia modifier for certain deep, complex, complicated, or markedly invasive surgical procedures when applied to anesthesia codes 00100, 00300, 00400, 00160, 00532, or 00920.
MAC may be appropriate for pediatric patients (Medicare-eligible and younger than 18) when documented using ICD-10-CM code T88.8XXA and clinical records justify the need for MAC.
Pharmacogenomics (PGx) testing is covered when it is reasonable and necessary per LCD L39063 and Medicare coverage rules for the beneficiary's clinical indication.

A56767, Billing and Coding: Heavy Metal Testing

A59915, Billing and Coding: Pharmacogenomic Testing

NGS-J6-L35074, Heavy Metal Testing

NGS-J6-L39995, Pharmacogenomic Testing

A57063, Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy

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