Does K91.1 require prior authorization?

No, K91.1 does not require prior authorization (high confidence). Covered without prior authorization.

`K91.1`, Postgastric surgery syndromes

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

The submitted CPT/HCPCS code must accurately describe the service performed.
All documentation must be maintained in the patient medical record and made available to the contractor upon request.
Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service).
The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.

Diagnostic colonoscopy is covered when the service meets the reasonable and necessary requirements specified in Local Coverage Determination L33671.
Vitamin B12 injections are covered only when reasonable and necessary per Local Coverage Determination L33967.
Diagnostic colonoscopy is covered when determined to be reasonable and necessary in accordance with Local Coverage Determination L38812.
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).

A55937, Billing and Coding: Diagnostic Colonoscopy

FIRST_COAST-L33671, Diagnostic Colonoscopy

FIRST_COAST-L33967, Vitamin B<sub>12</sub> Injections

NOVITAS-JH-L38812, Diagnostic Colonoscopy

A58428

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