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ICD-10-CM N80.30, Endometriosis of pelvic peritoneum, unspecified | No Prior Auth

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`N80.30`, Endometriosis of pelvic peritoneum, unspecified

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

This billing and coding article provides guidelines that complement Local Coverage Determination L34415 for CT of the abdomen and pelvis; consult LCD L34415 for specific coverage indications, limitations, and documentation requirements.
All listed documentation items are required for review; failure to submit any may affect decision outcome.
Submit history and physical/chart notes.
Document any conservative treatments provided, if applicable.

2 Active Policies

REGENCE-SUR218, Hysterectomy

A56421, Billing and Coding: CT of the Abdomen and Pelvis

Related Codes

D06.1(2 policies)D25.0(2 policies)A56.11(2 policies)D06.0(2 policies)D06.7(2 policies)D06.9(2 policies)A18.17(2 policies)D25.1(2 policies)

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If conservative management is relatively or absolutely contraindicated, specify the contraindications.

Provide clinical details of prior conservative treatments if they were tried and were ineffective or not tolerated.