Does N85.00 require prior authorization?

No, N85.00 does not require prior authorization (high confidence). Covered without prior authorization.

`N85.00`, Endometrial hyperplasia, unspecified

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Submit CPT code 58999 on the claim for the IUD insertion.
Use ICD-10 code N84.0 or codes N85.00–N85.02 on the claim to indicate endometrial hyperplasia.
Enter the phrase "hormone IUD" in the comment/narrative field of the CMS-1500 claim form or the equivalent electronic claim field.
Bill IUD insertion using CPT 58999 (Unlisted procedure, female genital system) with an appropriate endometrial hyperplasia diagnosis code (N85.01 or N85.00).

Insertion of a hormone-containing intrauterine device (IUD) to treat endometrial hyperplasia in patients with abnormal uterine bleeding who are unable to tolerate oral megestrol or are at high risk for complications of oral megestrol.
Progestin-containing (hormone) IUD insertion may be approved for Medicare beneficiaries diagnosed with simple endometrial hyperplasia without atypia (ICD-10 N85.01).
Progestin-containing (hormone) IUD insertion may be approved for Medicare beneficiaries with endometrial hyperplasia, unspecified (ICD-10 N85.00).
IUD insertion is an alternative management option for patients who are not reasonable surgical candidates or who wish to preserve fertility.
Progestin-containing intrauterine device (IUD) delivering progestins over 5 years is a reasonable treatment for endometrial hyperplasia without atypia in patients presenting with abnormal uterine bleeding.
Progestin-containing IUD may be used when patients with endometrial hyperplasia are unable to tolerate oral megestrol or develop high-risk complications from oral megestrol.

A55951, Billing and Coding: Endometrial Hyperplasia Treatment with Intrauterine Device (Hormone-Eluting)

A58649, Billing and Coding: IUD (Hormone-Eluting) for Endometrial Hyperplasia - CPT 58999

AETNA-CPB-0769, Endometrial Cancer Screening, Diagnosis, and Prognosis

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

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