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ICD-10-CM N42.0, Calculus of prostate | No Prior Auth

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`N42.0`, Calculus of prostate

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Key Coverage Criteria

To guide application of cryotherapy or brachytherapy for treatment of prostate cancer;or
To evaluate and stage prostate cancer or rectal cancer;or
Prostate-specific antigen (PSA) level greater than 3.0 ng/ml;or
Transrectal ultrasonography (TRUS) is consideredmedically necessaryforanyof the following indications:
To guide prostate biopsy when prostate cancer is suspected based onanyof the following:Abnormal digital rectal examination (DRE);orProstate-specific antigen (PSA) level greater than 3.0 ng/ml;orMedical history;or
Abnormal digital rectal examination (DRE);or

1 Active Policy

ANTHEM-CG-RAD-28, Transrectal Ultrasonography

Related Codes

C21.0(1 policies)C21.8(1 policies)C76.3(1 policies)C78.5(1 policies)C79.82(1 policies)D01.1(1 policies)D01.3(1 policies)76872(1 policies)

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