Does N13.70 require prior authorization?

No, N13.70 does not require prior authorization (high confidence). Covered without prior authorization.

`N13.70`, Vesicoureteral-reflux, unspecified

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

This billing and coding article provides guidelines that complement Local Coverage Determination L34415 for CT of the abdomen and pelvis; consult LCD L34415 for specific coverage indications, limitations, and documentation 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.
For diagnostic urodynamic tests, report the test result if known; if results are not available at time of claim, report the symptoms that prompted the test.
When a penile pressure cuff is used during a voiding pressure study, report CPT code 55899 and note the non-invasive urodynamic study in the narrative portion of the claim.

Urodynamic testing is covered when medical necessity is documented consistent with the related Local Coverage Determination (LCD) for Urodynamics.
Endoscopic injection of dextranomer/hyaluronic acid copolymer (Deflux), polydimethylsiloxane (Macroplastique), polytetrafluoroethylene (Teflon), or other bulking agents approved by the U.S. Food and Drug Administration (FDA) for vesicoureteral reflux (VUR) is medically necessary for the treatment of members with primary or secondary VUR who have any of the following conditions when conservative treatments (e.g., prophylactic antibiotics and clean intermittent catheterization) have failed:
Members with primary VUR (when conservative treatments have failed).
Members with secondary VUR (when conservative treatments have failed).
Children who have had a previously unsuccessful ureteral re-implantation.
Children who have stopped taking their medication as a result of drug intolerance or parental non-compliance.

NGS-J6-L33576, Urodynamics

A57455, Billing and Coding: Urodynamics

NGS-JK-L33576, Urodynamics

AETNA-CPB-0534, Vesicoureteral Reflux Treatment by Endoscopic Injection of Bulking Agents

A56421, Billing and Coding: CT of the Abdomen and Pelvis

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