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ICD-10-CM N21.9, Calculus of lower urinary tract, unspecified | No Prior Auth

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`N21.9`, Calculus of lower urinary tract, unspecified

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Key Coverage Criteria

Verification of suprapubic catheter placement;or
Removal of indwelling ureteral stents not amenable to office-based procedure;or
Lower genital tract trauma with suspicion of urinary tract involvement, including urethral stricture;or
Urine dribbling post voiding (for example, from a urethral diverticulum);or
Injection of therapeutic agents for urinary incontinence;or
Outpatient cystourethroscopy is consideredmedically necessaryforanyof the following indications:

1 Active Policy

ANTHEM-CG-SURG-51, Outpatient Cystourethroscopy

Related Codes

52001(1 policies)52005(1 policies)52007(1 policies)52010(1 policies)52204(1 policies)52214(1 policies)52224(1 policies)52000(1 policies)

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