Does K76.9 require prior authorization?

No, K76.9 does not require prior authorization (high confidence). Covered without prior authorization.

`K76.9`, Liver disease, unspecified

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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.
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.

Vitamin D assay testing billed to Medicare Part A or Part B MAC is covered when ordered by an authorized provider (physician or state-authorized non-physician) and the service is otherwise consistent with local coverage determination L33996.
A valid ICD-10-CM diagnosis code that best describes the patient's condition prompting the Vitamin D assay must be reported on the claim; for diagnostic tests, report the test result if known, otherwise report the presenting symptoms.
When a referring/ordering provider is required, the referring/ordering provider name and NPI must be reported on the claim.
Vitamin D assay testing is covered when the medical record documents medical necessity for the test, including the clinical reason for testing and any planned repeat testing and frequency.
Adjunctive imaging in suspected autoimmune pancreatitis (AIP) to evaluate main pancreatic duct narrowing, MPD integrity (secretin-MRCP may demonstrate duct-penetrating sign), and parenchymal features (but MRCP cannot fully replace ERCP in AIP diagnostic workup).
Imaging of biliary tree to help plan directed interventions (endoscopic or transhepatic) in complex biliary disease where MRCP may increase likelihood of success and decrease risk.

CGS-J15-L33996, Vitamin D Assay Testing

J15

CGS-J18-L33996, Vitamin D Assay Testing

J18

NGS-J6-L37535, Vitamin D Assay Testing

A57736, Billing and Coding: Vitamin D Assay Testing

NGS-J6-L35074, Heavy Metal Testing

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