Does N81.2 require prior authorization?

No, N81.2 does not require prior authorization (high confidence). Covered without prior authorization.

`N81.2`, Incomplete uterovaginal prolapse

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.
Each claim must include ICD-10-CM diagnosis code(s) that accurately reflect the patient's condition and the reason(s) the urodynamic service was performed.
For diagnostic urodynamic tests, report the test result if known; if results are not available at time of claim, report the symptoms that prompted the test.
When a penile pressure cuff is used during a voiding pressure study, report CPT code 55899 and note the non-invasive urodynamic study in the narrative portion of the claim.

Urodynamic testing is covered when medical necessity is documented consistent with the related Local Coverage Determination (LCD) for Urodynamics.
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].

NGS-J6-L33576, Urodynamics

A57455, Billing and Coding: Urodynamics

NGS-JK-L33576, Urodynamics

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.