Does N03.9 require prior authorization?

No, N03.9 does not require prior authorization (high confidence). Covered without prior authorization.

`N03.9`, Chronic nephritic syndrome with unspecified morphologic changes

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Medical records must document that the ultrasound was limited to retroperitoneal structures when billing CPT 76770/76775/76776, including images/findings demonstrating limitation to the retroperitoneum.
If the exam was expanded to include organs outside the retroperitoneum, documentation must reflect the expansion and support billing a full or limited abdominal ultrasound (CPT 76700/76705/76706).
Claims and documentation should follow the complementary Local Coverage Determination L34577 and any applicable LCD requirements.
Verify and document compliance with applicable NCCI edits and OPPS packaging rules prior to billing.

Retroperitoneal ultrasound (CPT 76770, 76775, 76776) is covered when the exam is limited solely to retroperitoneal structures.
A full (complete) or limited abdominal ultrasound (CPT 76700, 76705, 76706) is covered when the exam includes organs or structures outside the retroperitoneum or when primary findings involve non-retroperitoneal structures (e.g., gallbladder, liver, spleen, common bile duct).
Serum thallium testing is covered for beneficiaries with documented industrial thallium exposure and unexplained ataxia.
Serum tin testing is covered for beneficiaries with documented industrial tin exposure.
Serum aluminum testing is covered for beneficiaries on chronic dialysis with evidence suggesting aluminum toxicity or for beneficiaries with documented chronic industrial aluminum exposure.
Serum and/or urine antimony testing is covered for beneficiaries with documented prior treatment with antileishmaniasis agents or with documented chronic industrial antimony exposure.

NGS-J6-L35074, Heavy Metal Testing

A56767, Billing and Coding: Heavy Metal Testing

NGS-JK-L35074, Heavy Metal Testing

A55336, Billing and Coding: Retroperitoneal Ultrasound

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