Does N13.0 require prior authorization?

No, N13.0 does not require prior authorization (high confidence). Covered without prior authorization.

`N13.0`, Hydronephrosis with ureteropelvic junction obstruction

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.
Each claim must include ICD-10-CM diagnosis code(s) that accurately reflect the patient's condition and the reason(s) the urodynamic service was performed.

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).
Urodynamic testing is covered when medical necessity is documented consistent with the related Local Coverage Determination (LCD) for Urodynamics.
Urodynamic testing is covered for patients with history of radical pelvic surgery.
Urodynamic testing is covered for symptomatic pelvic organ prolapse that extends beyond the hymen.
Urodynamic studies are indicated only after an initial evaluation that includes an appropriate history, physical examination, and urinalysis with microscopy.

NGS-J6-L33576, Urodynamics

A57455, Billing and Coding: Urodynamics

NGS-JK-L33576, Urodynamics

A55336, Billing and Coding: Retroperitoneal Ultrasound

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