Does N46.021 require prior authorization?

No, N46.021 does not require prior authorization (high confidence). Covered without prior authorization.

`N46.021`, Azoospermia due to drug therapy

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

The patient's medical record must fully support the medical necessity for TRUS and include relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
For diagnostic tests, report the test result if known; if the result is not available, report the symptoms that prompted performance of the test.
Documentation supporting the service must be available to Medicare upon request.
When a referring/ordering physician is required, the claim must report the referring/ordering physician's name and NPI.

Transrectal ultrasound (TRUS) is covered when it is medically necessary and consistent with the related Local Coverage Determination (LCD) with supporting documentation in the medical record.
No covered indications are explicitly listed in this CPB. The bulletin primarily designates adoptive immunotherapy and cellular therapy approaches described below as experimental and investigational (i.e., not supported as effective).
Note / exception: "This policy does not apply to lifileucel for the treatment of advanced melanoma." (lifileucel is handled separately).
For CAR T therapies and specific agent coverage consult the related CPBs referenced (e.g., CPB 0920 Kymriah, CPB 0924 Yescarta, CPB 0980 Tecartus, CPB 0986 Breyanzi, CPB 0992 Abecma, CPB 1007 Carvykti).
Metastatic melanoma (use of TIL, T-cell-based ACT, IL-2/LAK combinations discussed)
Renal cell carcinoma (IL-2 with or without LAK/TIL studied)

NGS-J6-L33578, Transrectal Ultrasound

A57427, Billing and Coding: Transrectal Ultrasound

NGS-JK-L33578, Transrectal Ultrasound

CIGNA-0548, Scrotal Ultrasound

AETNA-CPB-0501, Gonadotropin-Releasing Hormone Analogs and Antagonists

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