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ICD-10-CM N42.9, Disorder of prostate, unspecified | No Prior Auth

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`N42.9`, Disorder of prostate, unspecified

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Key Coverage Criteria

Outpatient urine culture testing for bacteria is consideredmedically necessaryto evaluate any of the following situations:
Clinical signs or symptoms suggesting urinary tract infection (UTI);or
Abnormal urinalysis suggesting UTI;or
Asymptomatic bacteriuria in pregnant persons;or
Bacteriuria in individuals prior to undergoing an endoscopic urologic procedure;or
Suspected interstitial cystitis or bladder pain syndrome.

3 Active Policies

ANTHEM-CG-LAB-24, Outpatient Urine Culture

ANTHEM-CG-LAB-28, Prostate Specific Antigen Testing

ANTHEM-CG-RAD-28, Transrectal Ultrasonography

Related Codes

D49.59(3 policies)N40.0(3 policies)D40.0(3 policies)N40.3(2 policies)D29.1(2 policies)C79.82(2 policies)D07.5(2 policies)N41.9(2 policies)

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