Does N30.91 require prior authorization?

No, N30.91 does not require prior authorization (high confidence). Covered without prior authorization.

`N30.91`, Cystitis, unspecified with hematuria

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).
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

ANTHEM-CG-SURG-51, Outpatient Cystourethroscopy

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

A55336, Billing and Coding: Retroperitoneal Ultrasound

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

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