Does K90.81 require prior authorization?

No, K90.81 does not require prior authorization (high confidence). Covered without prior authorization.

`K90.81`, Whipple's disease

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.
The submitted medical record must support the selected ICD-10-CM code(s), and the submitted CPT/HCPCS code must accurately describe the service performed.
The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.

For tests that currently lack specific CPT codes (functional intracellular analysis and total antioxidant function), bill using CPT 84999 and add a note identifying which test was performed in the Remarks area for Part A claims and the Narrative area for Part B claims.
Coverage and reasonable/necessary determinations for assays for vitamins and metabolic function are governed by LCD L34914 and claims must meet that LCD's requirements to be covered.
25-hydroxy vitamin D testing (including fractions, if performed) is covered when deemed reasonable and necessary per Local Coverage Determination L33771.
Esophagogastroduodenoscopy (EGD) is covered when it meets the reasonable and necessary requirements specified in Local Coverage Determination L33583.
Acanthamoeba in corneal ulceration
Actinomyces, for identification of actinomyces species in tissue specimens

A56841, Billing and Coding: Vitamin D; 25 hydroxy, includes fraction(s), if performed

FIRST_COAST-L33583, Diagnostic and Therapeutic Esophagogastroduodenoscopy

FIRST_COAST-L33771, Vitamin D; 25 hydroxy, includes fraction(s), if performed

A57063, Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy

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