Does N43.40 require prior authorization?

No, N43.40 does not require prior authorization (high confidence). Covered without prior authorization.

`N43.40`, Spermatocele of epididymis, unspecified

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

The ordering physician/nonphysician practitioner must state the clinical indication and medical necessity for the study in the order.
The performing provider must maintain a permanent record of the performed study and interpretation, and must retain a copy of the ordering provider’s order and the test results.
The report must describe the studies performed, note any contrast media or radiopharmaceuticals used, record any significant patient reactions or complications, and compare with prior relevant imaging.
Variations from normal size must be documented with measurements and the report should address specific clinical questions or explain why questions cannot be answered.

Non‑invasive abdominal/visceral vascular studies are covered when the test results will be used to directly inform or change the patient's clinical management.
A preoperative non‑invasive abdominal/visceral vascular study is covered as reasonable and necessary for patients undergoing bypass surgery (one preoperative scan considered reasonable).
Medically necessary follow‑up non‑invasive abdominal/visceral vascular studies after angioplasty are covered as indicated by the vascular distribution treated.
Non‑invasive abdominal/visceral vascular studies performed in the inpatient hospital (place of service 21) or emergency room (place of service 23) are permitted and are not subject to the routine once‑per‑year outpatient limitation.
Acute scrotal pain or testicular torsion
Acute scrotal trauma or injury

WPS-J5-L35755, Non-Invasive Abdominal / Visceral Vascular Studies

A57591, Billing and Coding: Non-Invasive Abdominal / Visceral Vascular Studies

WPS-J8-L35755, Non-Invasive Abdominal / Visceral Vascular Studies

ANTHEM-CG-LAB-24, Outpatient Urine Culture

CIGNA-0548

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