Does K83.4 require prior authorization?

No, K83.4 does not require prior authorization (high confidence). Code is covered without prior authorization.

`K83.4`, Spasm of sphincter of Oddi

ICD-10-CM

No Prior Auth Required

Code is 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.
All documentation must be maintained in the patient’s medical record and made available to the contractor upon request.

Upper gastrointestinal endoscopy (diagnostic or therapeutic) is covered when determined reasonable and necessary per Local Coverage Determination L35350.
Vitamin D assay testing is payable under Medicare Part B when performed in an office (POS 11), independent clinic (POS 49), Federally Qualified Health Center (POS 50), or independent laboratory (POS 81).
Non-physician practitioners (e.g., nurse practitioners, clinical nurse specialists, physician assistants) may certify, order, and establish the plan of care for Vitamin D assay testing as authorized by State law (outpatient settings other than CORFs).
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])

A57484, Billing and Coding: Vitamin D Assay Testing

WPS-J5-L34658, Vitamin D Assay Testing

WPS-J8-L34658, Vitamin D Assay Testing

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

NOVITAS-JL-L35350

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