Does N28.86 require prior authorization?

No, N28.86 does not require prior authorization (high confidence). Covered without prior authorization.

`N28.86`, Ureteritis cystica

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.

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).
Pregnant and considered to be at high risk for type 2 diabetes mellitus;or
Impaired fasting glucose has been found on other testing;or
Blood glucose testing is consideredmedically necessaryfor individuals who meet any of the following criteria (A through Q):
Signs or symptoms of either of the following:Hypoglycemia;orHyperglycemia;or

ANTHEM-CG-LAB-30, Outpatient Laboratory-based Blood Glucose Testing

A55336, Billing and Coding: Retroperitoneal Ultrasound

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