Does K86.9 require prior authorization?

No, K86.9 does not require prior authorization (high confidence). Covered without prior authorization.

`K86.9`, Disease of pancreas, unspecified

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.
This billing/coding guideline complements LCD L33459 (Computerized Axial Tomography (CT), Thorax); follow the LCD for clinical coverage and any required documentation or prior authorization rules.

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).
No specific clinical indications are listed in this article; follow the Local Coverage Determination (LCD) L39400 for indications for magnesium testing or services.
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.
Preoperative evaluation of the common bile duct prior to laparoscopic cholecystectomy in persons with elevations of their transaminases or common bile duct dilatation on abdominal imaging (ultrasound or CT scan).

A57484, Billing and Coding: Vitamin D Assay Testing

WPS-J5-L34658, Vitamin D Assay Testing

WPS-J8-L34658, Vitamin D Assay Testing

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

A56580, Billing and Coding: Computerized Axial Tomography (CT), Thorax

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