Does N85.02 require prior authorization?

No, N85.02 does not require prior authorization (high confidence). Covered without prior authorization.

`N85.02`, Endometrial intraepithelial neoplasia [EIN]

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.
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.

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.
Medicare beneficiary with endometrial hyperplasia without atypia is eligible for coverage of a progestin-containing hormone IUD for management of the condition.
Use of a progestin-containing IUD may be considered when the patient is not a reasonable surgical candidate or wishes to preserve fertility.
ICD-10 diagnoses listed as 'covered if selection criteria are met' (examples listed in policy): C54.1 - C54.9 (Malignant neoplasm of corpus uteri [except isthmus]); D06.0 - D07.0 (Carcinoma in situ of cervix uteri or other and unspecified parts of uterus); N85.00 - N85.02 (Endometrial hyperplasia); N92.1 (Excessive and frequent menstruation with irregular cycle); N92.4 (Excessive bleeding in the premenopausal period); N92.5, N93.8 (Other abnormal bleeding from female genital tract); N93.9 (Abnor [...]
Endometrial biopsy (sampling) for histological tissue examination in the diagnostic evaluation of abnormal uterine bleeding in women suspected of having endometrial hyperplasia or endometrial carcinoma
Endometrial biopsy (sampling) for endometrial cancer surveillance in women with Lynch syndrome

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

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

AETNA-CPB-0510, Progestins

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

A53043, Billing and Coding: Endometrial Hyperplasia Treatment

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