Does N95.9 require prior authorization?

No, N95.9 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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`N95.9`, Unspecified menopausal and perimenopausal disorder

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

All services ordered or rendered to Medicare beneficiaries must be signed; providers/suppliers must notify beneficiaries in writing prior to rendering the service if aware the test/item/procedure may not be covered.
A valid ICD-10-CM diagnosis code that best describes the patient's condition must be reported on the claim; claims without a valid ICD-10-CM code will be returned as incomplete under Section 1833(e).
For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.

When services are likely to be non-covered, use an Advance Beneficiary Notice (ABN) and the appropriate modifier (-GA, -GX, -GY, or -GZ) as applicable; for Part A claims with GA, include occurrence code 32 and the date of the ABN and have Form CMS-R-131 signed by the beneficiary.

Key Coverage Criteria

Bone mass measurement tests are covered when ordered by the treating physician or a qualified non-physician practitioner authorized by state law.
An initial bone mass measurement is covered (Medicare reimbursement for an initial bone mass measurement may be allowed only once, regardless of sites studied).
A DXA confirmatory test may be performed and covered as a baseline for future monitoring (exception to the 'one type only' rule).
CPT code 77082 (vertebral fracture assessment) is covered when medically necessary, with symptoms documented and when results are anticipated to be used in patient management.
Bone mass measurement services are covered when they meet the clinical indications and medical necessity criteria specified in the related Local Coverage Determination L39268.
Primary hypogonadism (congenital or acquired) or hypogonadotropic hypogonadism (congenital or acquired) when ALL of the following criteria are met: member is a biological male or a person that self-identifies as male; member is at least 18 years of age; and member has at least two confirmed low morning serum total testosterone concentrations based on the reference laboratory range or current practice guidelines.

10 Active Policies

CGS-J15-L36460, Bone Mass Measurement

J15

CGS-J18-L36460, Bone Mass Measurement

J18

CIGNA-0398, Transvaginal Ultrasound, Non-Obstetrical

AETNA-CPB-0304, Fibroid Treatment

AETNA-CPB-0327, Infertility

AETNA-CPB-0345, Implantable Hormone Pellets

AETNA-CPB-0528, Testosterone Undecanoate (Aveed) Injection

AETNA-CPB-0608, Salivary Tests

A57132, Billing and Coding: Bone Mass Measurement

A59040, Billing and Coding: Bone Mass Measurement

`N95.9`, Unspecified menopausal and perimenopausal disorder

Prior Authorization

Documentation Required

Key Coverage Criteria

10 Active Policies

Related Codes

Have a follow-up question?

N95.9, Unspecified menopausal and perimenopausal disorder

Prior Authorization

Documentation Required

Key Coverage Criteria

10 Active Policies

Related Codes

Have a follow-up question?

`N95.9`, Unspecified menopausal and perimenopausal disorder