Does N02.B9 require prior authorization?

No, N02.B9 does not require prior authorization (high confidence). Covered without prior authorization.

`N02.B9`, Other recurrent and persistent immunoglobulin A nephropathy

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

The article provides billing/coding guidance that complements LCD L39400; use the documentation, prior authorization, and claim submission requirements specified in LCD L39400 and the local contractor's instructions.

No specific clinical indications are listed in this article; follow the Local Coverage Determination (LCD) L39400 for indications for magnesium testing or services.
Tonsillectomy is consideredmedically necessaryfor individuals 18 years of age and older who meet one or more of the criteria below:
A history of recurrent acute throat infection with a frequency of at least:Three or more episodes in the previous 6 months;orFour or more episodes in the previous 12 months;andDocumentation in the medical record for each episode of sore throat which includes at least one of the following:Temperature greater than 38.3 Â°C (100.9 Â°F);orCervical adenopathy;orTonsillar exudate or erythema;orPositive test for Group A Ã-hemolytic streptococcus (GABHS);or
Three or more episodes in the previous 6 months;or
Four or more episodes in the previous 12 months;and
Documentation in the medical record for each episode of sore throat which includes at least one of the following:Temperature greater than 38.3 Â°C (100.9 Â°F);orCervical adenopathy;orTonsillar exudate or erythema;orPositive test for Group A Ã-hemolytic streptococcus (GABHS);or

ANTHEM-CG-SURG-113, Tonsillectomy with or without Adenoidectomy for Adults

ANTHEM-CG-LAB-21, Serum Iron Testing

ANTHEM-CG-SURG-51, Outpatient Cystourethroscopy

A59186, Billing and Coding: Magnesium

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