Does K94.09 require prior authorization?

No, K94.09 does not require prior authorization (high confidence). Covered without prior authorization.

`K94.09`, Other complications of colostomy

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.
Colonoscopy/sigmoidoscopy/proctosigmoidoscopy is covered for surveillance of colonic neoplasia in patients with a history of colorectal cancer or colonic polyps.
A follow-up procedure is covered 1 year after surgery for treatment of colorectal cancer when the patient is identified as high-risk for colon cancer and is eligible for continued screenings.
Diagnostic colonoscopy is covered when determined to be reasonable and necessary in accordance with Local Coverage Determination L38812.
Examination of the entire colon to evaluate for synchronous cancer or neoplastic polyps in a patient with a treatable colon cancer or neoplastic polyp.
Colonoscopy to evaluate an abnormality on other imaging (e.g., barium enema, CT, MRI, ultrasound, PET) likely to be clinically significant such as a filling defect or stricture.

A55937, Billing and Coding: Diagnostic Colonoscopy

FIRST_COAST-L33671, Diagnostic Colonoscopy

NOVITAS-JH-L38812, Diagnostic Colonoscopy

A58428, Billing and Coding: Diagnostic Colonoscopy

NOVITAS-JL-L38812

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