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ICD-10-CM N46.123, Oligospermia due to obstruction of efferent ducts | No Prior Auth

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`N46.123`, Oligospermia due to obstruction of efferent ducts

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

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.

Key Coverage Criteria

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.
Acute scrotal pain or testicular torsion
Acute scrotal trauma or injury
Suspected infectious or inflammatory scrotal disease (e.g., epididymitis, orchitis, epididymo-orchitis, abscess of epididymis or testis)
Scrotal neoplasm or mass (including suspected intratesticular mass)
Family history of testicular cancer / germ cell tumor (GCT)

4 Active Policies

NGS-J6-L33578, Transrectal Ultrasound

J6

A57427, Billing and Coding: Transrectal Ultrasound

J6

NGS-JK-L33578, Transrectal Ultrasound

JK

CIGNA-0548, Scrotal Ultrasound

Related Codes

N46.023(4 policies)N46.029(4 policies)N46.021(4 policies)N46.022(4 policies)N46.024(4 policies)N46.025(4 policies)N46.01(4 policies)N46.121(4 policies)

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Claims must be submitted with the most appropriate and applicable covered diagnosis code(s) listed in the policy; services billed without a covered diagnosis code will be denied.

Clinical documentation must support one of the listed medically necessary indications (e.g., documentation of acute scrotal pain, trauma, suspected torsion, mass, infertility evaluation, family history of testicular cancer, varicocele, hydrocele, nonpalpable testes age ≥6 months, suspected occult inguinal hernia).