Does N85.8 require prior authorization?

No, N85.8 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

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`N85.8`, Other specified noninflammatory disorders of uterus

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Documentation Required

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.
endometrial evaluation by biopsy, dilatation and curettage (D&C) fails to show evidence of remediable pathology
diagnostic evaluation of the uterine cavity by ultrasound, sonohysterogram or hysteroscopy failed to show evidence of remediable pathology

Key Coverage Criteria

Endometrial ablation is considered medically necessary as an alternative to hysterectomy for the treatment of menorrhagia or excessive anovulatory bleeding.
Endometrial ablation is considered medically necessary for residual menstrual bleeding after androgen treatment in an individual with confirmed gender dysphoria undergoing female to male hormonal sex reassignment* therapy.
uterus size of < 12 weeks' gestation (i.e., uterine length of less than 13 centimeters [cm] and anterior-posterior width of less than 7 cm )
failure, intolerance or contraindication of hormonal treatment for at least three months
endometrial evaluation by biopsy, dilatation and curettage (D&C) fails to show evidence of remediable pathology
diagnostic evaluation of the uterine cavity by ultrasound, sonohysterogram or hysteroscopy failed to show evidence of remediable pathology

2 Active Policies

CIGNA-0013, Endometrial Ablation

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

`N85.8`, Other specified noninflammatory disorders of uterus

Prior Authorization

Documentation Required

Key Coverage Criteria

2 Active Policies

Related Codes

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N85.8, Other specified noninflammatory disorders of uterus

Prior Authorization

Documentation Required

Key Coverage Criteria

2 Active Policies

Related Codes

Have a follow-up question?

`N85.8`, Other specified noninflammatory disorders of uterus