Does K80.50 require prior authorization?

No, K80.50 does not require prior authorization (high confidence). Covered without prior authorization.

`K80.50`, Calculus of bile duct without cholangitis or cholecystitis 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.
Continuation of Therapy: "Aetna considers continuation of panitumumab (Vectibix) therapy medically necessary in members requesting reauthorization for an indication listed in Section I when there is no evidence of unacceptable toxicity or disease progression while on the current regimen."
FDA-Approved Indications (background information included in policy): "Vectibix is indicated for the treatment of patients with wild-type RAS (defined as wild-type in both KRAS and NRAS as determined by an FDA-approved test for this use) metastatic colorectal cancer (mCRC): As first-line therapy in combination with FOLFOX; As monotherapy following disease progression after prior treatment with fluoropyrimidine-, oxaliplatin-, and irinotecan-containing chemotherapy."
C18.0 - C18.9 Malignant neoplasm of colon [covered for left-sided tumors only]
C19 - C21.8 Malignant neoplasm of rectosigmoid junction, rectum, anus and anal canal
CPT 81275 KRAS gene analysis; variants in exon 2 (eg, codons 12 and 13) — covered if selection criteria are met

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)

AETNA-CPB-0748, Panitumumab (Vectibix)

A56389, Billing and Coding: Upper Gastrointestinal Endoscopy and Visualization

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