Does N91.0 require prior authorization?

No, N91.0 does not require prior authorization (high confidence). Covered without prior authorization.

`N91.0`, Primary amenorrhea

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Medical records must include history and physical notes, laboratory results, and documentation of signs and symptoms that warrant the head/neck diagnostic imaging.
Accurate HCPCS/CPT coding must be submitted to differentiate CT and MRI scans from other radiology services and to support coverage determinations.
Documentation and supporting information must be available to Medicare upon request.
Providers should check and apply Correct Coding Initiative (CCI) edits and applicable LCD guidance for correct code combinations before billing.

CT or MRI scans of the head or neck are covered when the medical record documents the scan is reasonable and necessary for diagnostic evaluation.
Coverage requires documentation supporting clinical indication such as history and physical exam findings, laboratory results, and signs or symptoms that justify the diagnostic test.
Covered ICD-10 diagnoses if selection criteria are met: E23.0 (Hypopituitarism [hypogonadotropic hypogonadism]), E29.1 (Testicular hypofunction [primary]), E30.0 (Delayed puberty), F64.0 - F64.9 (Gender identity disorders), Z87.890 (Personal history of sex reassignment)
Delayed male puberty
CPT/HCPCS: CPT 11980 (Subcutaneous hormone pellet implantation) is covered for testosterone only if selection criteria are met; HCPCS S0189 (Testosterone pellet, 75 mg) covered if selection criteria are met.
Gender dysphoria when all of the following are met: The member has a diagnosis of gender dysphoria; and The member is able to make an informed decision to engage in hormone therapy; and The member's comorbid conditions are reasonably controlled; and The member has been educated on any contraindications and side effects to therapy; and Before the start of therapy, the member has been informed of fertility preservation options; and For members less than 18 years of age, this medication will be pre [...]

ANTHEM-CG-LAB-21, Serum Iron Testing

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

ANTHEM-CG-LAB-20, Thyroid Testing

ANTHEM-CG-LAB-11, Screening for Vitamin D Deficiency in Average Risk Individuals

ANTHEM-CG-LAB-30, Outpatient Laboratory-based Blood Glucose Testing

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