Does K76.6 require prior authorization?

No, K76.6 does not require prior authorization (high confidence). Covered without prior authorization.

`K76.6`, Portal hypertension

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Claims must be submitted with an ICD-10-CM code that represents the reason the procedure was performed, billed to the highest level of specificity, and linked to the appropriate CPT/HCPCS procedure code.
All documentation must be maintained in the patient's medical record, with every page legible, including appropriate patient identification and dates of service, and must include the legible signature of the physician or responsible non-physician practitioner.
The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
Medical record documentation should list the type and duration of conservative (non-stent) treatment attempted, as applicable per the LCD.

Endovenous stenting is covered when used to treat severely symptomatic venous obstructions in accordance with LCD L38231.
Wireless capsule endoscopy of the small bowel (including esophagus through ileum) is billed with CPT 91110 when clinically indicated.
Wireless capsule endoscopy limited to the esophagus is billed with CPT 91111 when clinically indicated.
Capsule endoscopy may be used when attempts were made to identify a gastrointestinal bleeding source but the site was not identified by prior colonoscopy or endoscopy.
Capsule endoscopy is indicated when the patient is not a candidate for conventional endoscopy and the medical record documents specific comorbidities/complicating conditions and explains why the risk/benefit ratio for conventional endoscopy is unfavorable.
The medical record must support how the capsule endoscopy would contribute to the patient’s care (expected diagnostic or management impact).

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J15-L34081, Endoscopy by Capsule

J15

CGS-J18-L34081, Endoscopy by Capsule

J18

CGS-J18-L34045, Non-Invasive Vascular Studies

J18

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

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