Does N20.1 require prior authorization?

No, N20.1 does not require prior authorization (high confidence). Covered without prior authorization.

`N20.1`, Calculus of ureter

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.
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.

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).
Vitamin D assay testing is covered when the medical record documents medical necessity for the test, including the clinical reason for testing and any planned repeat testing and frequency.
Vitamin D assay testing is covered when ordered for evaluation of a patient's vitamin D status and billed with a valid ICD-10-CM diagnosis code that best describes the patient's condition.
No specific clinical indications are listed in this article; follow the Local Coverage Determination (LCD) L39400 for indications for magnesium testing or services.
Measure 25-hydroxyvitamin D (25-OH) for patients with chronic kidney disease stage III or greater.

A57736, Billing and Coding: Vitamin D Assay Testing

NGS-J6-L37535, Vitamin D Assay Testing

NGS-JK-L37535, Vitamin D Assay Testing

A57718, Billing and Coding: Vitamin D Assay Testing

A59170, Billing and Coding: Vitamin D Assay Testing

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