Does N28.9 require prior authorization?

No, N28.9 does not require prior authorization (high confidence). Covered without prior authorization.

`N28.9`, Disorder of kidney and ureter, 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.
Evidence of blood levels demonstrating significant gammaglobulin deficiency prior to initial treatment should be documented where appropriate.
Medical record must document medical necessity to initiate and continue IVIG, including history and physical and office/progress notes.
Test results with written interpretation must be in the record, including relevant diagnostic testing (e.g., NCS, EMG, CSF, serum immunoprotein, muscle/nerve biopsy) as appropriate to the treated condition.

Off-label IVIG use may be billed when supported by the applicable Local Coverage Determination (LCD) and by documentation of medical necessity; off-label is defined as not in Medicare-approved compendia or the FDA label.
IVIG may be used in bone marrow/stem cell transplantation when the recipient was CMV seropositive before transplantation, or after allogeneic transplantation for hematologic neoplasm when both donor and recipient were CMV seronegative.
IVIG may be used in solid organ transplantation when the donor was CMV seropositive and the recipient was CMV seronegative prior to transplantation.
IVIG may be used for recurrent severe infections when there is documented severe or absent IgG subclass deficiency or clinically significant functional humoral immunity deficiency (failure to produce specific antibodies) with a history of recurrent infections.
IVIG may be used for neuromuscular disorders when objective improvement is demonstrated and continued treatment is required, provided quantitative assessments are documented to monitor progress.
Use of IVIG for autoimmune mucocutaneous blistering disease should follow CMS National Coverage Determination (Medicare NCD Chapter 1, Section 250.3).

NGS-J6-L39314, Off-Label Use of Intravenous Immune Globulin (IVIG)

A59105, Billing and Coding: Off-Label Use of Intravenous Immune Globulin (IVIG)

NGS-JK-L39314, Off-Label Use of Intravenous Immune Globulin (IVIG)

AETNA-CPB-0661, Joint Resurfacing

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

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