Does N81.10 require prior authorization?

No, N81.10 does not require prior authorization (high confidence). Covered without prior authorization.

`N81.10`, Cystocele, unspecified

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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.
If MR defecography is proposed, documentation must address the reasons for choosing MR (note: MR defecography is considered investigational for CPB-listed indications and MR-related CPTs are listed as not covered for CPB indications).
Documented chronic constipation as defined in the policy: presence of 2 or more of the following symptoms for at least 3 months: 'Lumpy and/or hard stools at least 1/4 of the time; or Sensation of incomplete evacuation at least 1/4 of the time; or Straining at defecation at least 1/4 of the time; or Two or fewer bowel movements per week.'

Inappropriate contraction of the puborectalis muscle.
Pelvic organ prolapse.
Covered CPT code (if selection criteria are met): 74270 (Radiologic examination, colon; barium enema, with or without KUB).
ICD-10 codes covered if selection criteria are met:
K59.00 - K59.09 (Constipation) [policy notes: not covered for routine evaluation; covered only if selection criteria met].
K59.4 (Anal spasm [proctalgia fugax] [inappropriate contraction of the puborectalis muscle]).

AETNA-CPB-0718, Defecography

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

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