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ICD-10-CM N53.11, Retarded ejaculation | No Prior Auth

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`N53.11`, Retarded ejaculation

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.
Plantar Fasciitis
Peptic Ulcer
Post-Operative Ileus
Post-Prandial Distress Syndrome
Post-Stroke Shoulder Pain

6 Active Policies

NGS-J6-L33578, Transrectal Ultrasound

J6

A57427, Billing and Coding: Transrectal Ultrasound

J6

NGS-JK-L33578, Transrectal Ultrasound

JK

ANTHEM-CG-LAB-24, Outpatient Urine Culture

AETNA-CPB-0135, Acupuncture and Dry Needling

Related Codes

N46.01(4 policies)D29.1(4 policies)D40.0(4 policies)N40.0(4 policies)A18.14(4 policies)R36.1(4 policies)C19(3 policies)C21.2(3 policies)

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Documentation that the patient's diagnosis meets one of the covered indications (e.g., chronic neck pain or chronic headache with minimum 12 weeks duration where applicable).

Documentation of duration of symptoms when chronicity is required (policy explicitly requires minimum 12 weeks duration for chronic neck pain and chronic headache).

AETNA-CPB-0327, Infertility