Does K81.9 require prior authorization?

No, K81.9 does not require prior authorization (high confidence). Covered without prior authorization.

`K81.9`, Cholecystitis, 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.
No explicit documentation requirements are stated in the policy
Policy references clinical data elements commonly used in interpretation (e.g., gallbladder ejection fraction values such as <40% or <35%, reproduction of biliary pain during CCK-CS, prior ultrasonography showing cholelithiasis), but the policy does not mandate specific documentation or test result thresholds as coverage preconditions
Documented clinical indication for MRCP (e.g., symptoms such as obstructive jaundice, cholangitis, biliary-type abdominal pain, pancreatitis).

CPT codes covered if selection criteria are met: 78226 (Hepatobiliary system imaging, including gallbladder when present)
ICD-10 codes covered if selection criteria are met: K82.A1 - K82.A2 (Disorders of gallbladder in diseases classified elsewhere)
ICD-10 codes covered if selection criteria are met: K83.1 (Obstruction of bile duct [common])
ICD-10 codes covered if selection criteria are met: K83.4 (Spasm of sphincter of Oddi)
CPT codes covered if selection criteria are met: 78227 (with pharmacologic intervention, including quantitative measurement(s) when performed)
HCPCS codes covered if selection criteria are met: J2805 (Injection, sincalide, 5mcg)

AETNA-CPB-0266, Cholecystokinin Cholescintigraphy

AETNA-CPB-0384, Magnetic Resonance Cholangiopancreatography

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

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