Does N46.11 require prior authorization?

No, N46.11 does not require prior authorization (high confidence). Covered without prior authorization.

`N46.11`, Organic oligospermia

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.
ICD-10 codes covered if selection criteria are met: E29.1 (Testicular hypofunction); I86.1 (Scrotal varices); N46.023 (Azoospermia due to obstruction of efferent ducts); N46.11 - N46.129 (Oligospermia)
Percutaneous embolization (by balloon or metallic coil) or ligation is medically necessary for treatment of varicocele for adolescents with grade 2 or 3 varicoceles associated with ipsilateral testicular growth retardation.
Percutaneous embolization (by balloon or metallic coil) or ligation is medically necessary for treatment of varicocele for males with infertility problems who have decreased sperm motility and lower sperm concentrations.
Percutaneous embolization (by balloon or metallic coil) or ligation is medically necessary for treatment of post-surgical (ligation) recurrence of varicoceles.
Percutaneous embolization (by balloon or metallic coil) or ligation is medically necessary for treatment of scrotal pain associated with varicoceles.

NGS-J6-L33578, Transrectal Ultrasound

A57427, Billing and Coding: Transrectal Ultrasound

NGS-JK-L33578, Transrectal Ultrasound

AETNA-CPB-0413, Varicocele: Selected Treatments

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