Does N94.89 require prior authorization?

No, N94.89 does not require prior authorization (high confidence). Covered without prior authorization.

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`N94.89`, Other specified conditions associated with female genital organs and menstrual cycle

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high 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.
If a specific etiology for FSD is discovered on history, physical, and laboratory examination, the suspected etiology may be treated. ('If a specific etiology for FSD is discovered on history, physical, and laboratory examination, the suspected etiology may be treated.')
Trials and safety assessments described for drugs/devices frequently included: physical examination, cervical Papanicolaou test, clinical laboratory analyses, and assessment of endometrial thickness and histology (as in the ospemifene Phase III trial).

For conservative management: the document describes basic (non-pharmacologic) treatment strategies to be applied when no specific etiology is discovered — educational interventions, enhancement of stimulation, lubricants, counseling and psychotherapy — implying documentation of prior conservative therapies where appropriate before advanced/experimental interventions.

Key Coverage Criteria

Vyleesi (bremelanotide) is a melanocortin receptor agonist indicated for the treatment of pre-menopausal women with acquired, generalized HSDD as characterized by low sexual desire that causes marked distress or interpersonal difficulty and is not due to a co-existing medical or psychiatric condition, problems with the relationship, or the effects of a medication or drug substance.
EMG-guided onabotulinumtoxinA (Botox) injections into pelvic floor muscles: pilot data suggest benefit for women with refractory high-tone pelvic floor dysfunction (HTPFD) who have failed conservative therapy (Morrissey et al., 2015).
Radiofrequency (RF) thermal therapy (including Viveve cryogen-cooled monopolar RF and monopolar RF devices such as ThermiVa) has been used in studies for vaginal introital laxity, vulvo-vaginal laxity after vaginal delivery, improvement in sexual function and (in some reports) stress urinary incontinence.
Reverse-gradient / low-energy RF for vaginal introital laxity: single 30-minute office procedures reported improved Female Sexual Function Index (FSFI) and Female Sexual Distress Scale-Revised (FSDS-R) scores in small, single-arm studies (Sekiguchi et al., 2013; Millheiser et al., 2010).
Phosphodiesterase type 5 inhibitors (PDE5is) have been evaluated for female sexual dysfunction; a systematic review concluded 'PDE5is could be an effective treatment modality for FSD' in some trials (Gao et al., 2016), though other summaries (UpToDate) report inconsistent results.
Hyaluronic acid (HA) vaginal preparations: systematic review findings suggested 'treatment with HA, when compared with the use of estrogens, did not present a significant difference' for epithelial atrophy, vaginal pH, dyspareunia, and cell maturation — i.e., HA has been studied as an alternative for vaginal atrophy.

10 Active Policies

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

ANTHEM-CG-LAB-27, Human Chorionic Gonadotropin Testing

AMBETTER-CP.MP.97, Testing for Select Genitourinary Conditions

AETNA-CPB-0231, Grenz Ray Therapy for Skin Disorders

AETNA-CPB-0348, Recurrent Pregnancy Loss

AETNA-CPB-0441, Pelvic Congestion Syndrome Treatments

AETNA-CPB-0530, Transvaginal Ultrasonography

AETNA-CPB-0574, Female Sexual Dysfunction (FSD)

REGENCE-SUR218, Hysterectomy

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

`N94.89`, Other specified conditions associated with female genital organs and menstrual cycle

Prior Authorization

Documentation Required

Key Coverage Criteria

10 Active Policies

Related Codes

Have a follow-up question?

N94.89, Other specified conditions associated with female genital organs and menstrual cycle

Prior Authorization

Documentation Required

Key Coverage Criteria

10 Active Policies

Related Codes

Have a follow-up question?

`N94.89`, Other specified conditions associated with female genital organs and menstrual cycle