Does K80.30 require prior authorization?

No, K80.30 does not require prior authorization (high confidence). Covered without prior authorization.

`K80.30`, Calculus of bile duct with cholangitis, unspecified, without obstruction

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

This billing and coding guidance complements Local Coverage Determination L34434; follow LCD L34434 for clinical coverage criteria and required documentation for claims.
All services billed with unlisted procedure codes must include sufficient medical records and supporting documentation to allow development and medical review.
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.

Upper gastrointestinal endoscopy (diagnostic or therapeutic) is covered when determined reasonable and necessary per Local Coverage Determination L35350.
Upper gastrointestinal endoscopy (EGD) is covered for persistent upper abdominal distress that continues despite an appropriate trial of therapy.
EGD is covered for upper abdominal distress associated with signs suggesting serious organic disease, e.g., prolonged anorexia or weight loss.
EGD is covered for dysphagia (difficulty swallowing) or odynophagia (painful swallowing).
EGD is covered for persistent or recurrent gastroesophageal reflux symptoms despite appropriate medical therapy.
EGD is covered for persistent vomiting of unknown cause.

NOVITAS-JH-L35350, Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)

NOVITAS-JL-L35350, Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)

A57414, Billing and Coding: Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)

A56389, Billing and Coding: Upper Gastrointestinal Endoscopy and Visualization

A56421, Billing and Coding: CT of the Abdomen and Pelvis