Does N94.9 require prior authorization?

No, N94.9 does not require prior authorization (high confidence). Covered without prior authorization.

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`N94.9`, Unspecified condition 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

No specific documentation requirements, prior authorization, or required medical records/test results are specified in this policy bulletin.
Note: External guidance cited (NICE 2007) recommends use only in research settings (controlled trials, closely observed case series and/or contribution to a register), which would imply research documentation if used in that context, but Aetna's CPB itself does not list documentation requirements.
None specified in the CPB. (The document does not list explicit medical record, test result, or clinical documentation requirements for coverage or for investigational determinations.)

Key Coverage Criteria

None — Aetna considers Grenz ray therapy experimental and investigational for the treatment of dermatologic conditions because there is inadequate evidence in the published peer-reviewed medical literature regarding the effectiveness of Grenz ray therapy in the treatment of skin disorders.
Endometriosis
None explicitly listed as covered in this CPB. The policy identifies the following procedures as experimental and investigational (i.e., effectiveness not established and thus not supported by this policy): dorsal root ganglion stimulation; hypogastric plexus neurolysis for the treatment of chronic pelvic pain associated with endometriosis; peritoneal excision (stripping) for the treatment of endometriosis; uterine nerve ablation (UNA), laparoscopic uterine nerve ablation (LUNA) and presacral n [...]
Other indications related to pelvic pain addressed by selected treatments (policy scope: selected treatments for chronic pelvic pain, endometriosis, and other indications)
H1299R Factor V (FV) variant (rs1800595): pooled analysis showed the variant was “slightly associated with RPL albeit without significance … demonstrated that there is no clear association between the FV H1299R variant and RPL.” (Capra et al, 2022) — indicating limited/uncertain utility of testing.
Maternal ApoE genotyping: “ε4 allele was found to confer an increased risk of RPL compared to the ε3 allele … Subgroup analysis ... revealed that these associations were restricted to the Asian population.” (Cargnin et al, 2023) — suggesting possible relevance of ApoE genotyping in Asian women.

6 Active Policies

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-0530, Transvaginal Ultrasonography

AETNA-CPB-0754, Chronic Pelvic Pain, Endometriosis, and Other Indications: Selected Treatments

REGENCE-SUR218, Hysterectomy

`N94.9`, Unspecified condition associated with female genital organs and menstrual cycle

Prior Authorization

Documentation Required

Key Coverage Criteria

6 Active Policies

Related Codes

Have a follow-up question?

N94.9, Unspecified condition associated with female genital organs and menstrual cycle

Prior Authorization

Documentation Required

Key Coverage Criteria

6 Active Policies

Related Codes

Have a follow-up question?

`N94.9`, Unspecified condition associated with female genital organs and menstrual cycle