Does N31.9 require prior authorization?

No, N31.9 does not require prior authorization (high confidence). Covered without prior authorization.

`N31.9`, Neuromuscular dysfunction of bladder, unspecified

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

All documentation must be maintained in the patient's medical record, legible, include patient identification (e.g., full name, dates of service), and be made available to the contractor upon request.
The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
The submitted medical record must support the selected ICD-10-CM code(s), the submitted CPT/HCPCS code must describe the service performed, and the record must clearly document medical necessity, the indication for ordering the test, and a clear diagnostic impression.
If documentation is requested, providers must submit a hard copy of waveforms and/or a complete written report with interpretation sufficient to support that the test was medically reasonable and necessary.

Nerve conduction studies (NCS) without needle EMG (NEMG) are allowed for individuals being evaluated for carpal tunnel syndrome or tarsal tunnel syndrome when one of the following ICD-10-CM codes is reported: G56.01, G56.02, G56.03, G56.11, G56.12, G56.13, G56.21, G56.22, G56.23, G57.51, G57.52, or G57.53.
NCS without NEMG is allowed for individuals with significant lymphedema in the affected extremity when ICD-10-CM code I89.0 is reported in addition to the primary diagnosis.
NCS without NEMG is allowed for individuals treated with anticoagulants when ICD-10-CM code Z79.01 or Z79.02 is reported in addition to the primary diagnosis.
Urodynamic testing is covered when medical necessity is documented consistent with the related Local Coverage Determination (LCD) for Urodynamics.
Botulinum toxin administration is covered when it meets the reasonable and necessary requirements of LCD L33274.
Use of botulinum toxin for management of chronic migraine is supported when documentation shows a history of migraines occurring greater than or equal to 15 days per month.

CGS-J15-L34085, Post-Void Residual Urine and/or Bladder Capacity by Ultrasound

J15

CGS-J15-L39857, Botulinum Toxin Injections

J15

CGS-J15-L39856, Botulinum Toxin Injections

J15

CGS-J18-L39857, Botulinum Toxin Injections

J18

CGS-J18-L34085

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