Does N83.299 require prior authorization?

No, N83.299 does not require prior authorization (high confidence). Covered without prior authorization.

`N83.299`, Other ovarian cyst, unspecified side

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

For Morton's neuroma: documentation that conservative treatments (including orthotic use) and corticosteroid injections have failed.
For symptomatic renal cysts: documentation that the cyst is symptomatic (pain, hematuria, and/or hypertension) and measures 3 to 20 cm in size.
For active esophageal variceal hemorrhage: documentation that the person failed to adequately respond to or cannot undergo endovenous ligation (EVL).
For pediatric rectal prolapse: patient age consistent with pediatric population and diagnosis (ICD-10 K62.3).

Percutaneous aspiration with sclerotherapy (PAS) for symptomatic simple hepatic cysts (SHC)
Intravesical dextrose prolotherapy for bladder pain syndrome / interstitial cystitis (IC/BPS)
Percutaneous aspiration and sclerotherapy (AS/PAS) for symptomatic simple renal cysts (SRCs)
Endoscopic injection sclerotherapy (EIS) as a treatment option for acute esophageal variceal bleeding in cirrhosis (alternative to endoscopic variceal ligation)
Active esophageal variceal hemorrhage in persons who failed to adequately respond to or cannot undergo endovenous ligation (EVL)
Aneurysmal bone cyst

ANTHEM-CG-MED-84, Non-Obstetric Gynecologic Duplex Ultrasonography of the Abdomen and Pelvis in the Outpatient Setting

AETNA-CPB-0207, Prolotherapy and Sclerotherapy

AETNA-CPB-0530, Transvaginal Ultrasonography

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