Does N35.92 require prior authorization?

No, N35.92 does not require prior authorization (high confidence). Covered without prior authorization.

`N35.92`, Unspecified urethral stricture, female

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.
Laboratory values as applicable (e.g., PSA measurements reported in many trials and used as a secondary outcome).
Imaging/angiographic documentation for PAE (prostatic arterial anatomy identification) and documentation of technical feasibility or reasons for technical failure.
Erectile and ejaculatory function assessment (IIEF-5 or IIEF-15, MSHQ, MSHQ-EjD, SHIM) where preservation of sexual function is a treatment goal.

ICD-10 codes covered if selection criteria are met: N35.010 - N35.92 Urethral stricture
PAE can be considered in patients with hematuria of prostatic origin as a method of achieving cessation of bleeding. (Level of Evidence: D; strength of recommendation: strong)
Alpha adrenergic blockers (alfuzosin, doxazosin, silodosin, tamsulosin, and terazosin)
Aquablation (AquaBeam, water jet hydrodissection)
Hormonal manipulation (including finasteride, dutasteride, and dutasteride plus tamsulosin)
Interstitial laser coagulation of the prostate (ILCP)

ANTHEM-CG-SURG-51, Outpatient Cystourethroscopy

AETNA-CPB-0079, Benign Prostatic Hyperplasia

AETNA-CPB-0697, Intraoperative Neurophysiological Monitoring

AETNA-CPB-0784, Blood and Adipose Tissue Derived Products for Selected Indications

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

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