Does N97.9 require prior authorization?

No, N97.9 does not require prior authorization (low confidence). No active coverage policies found for this code.

`N97.9`, Female infertility, unspecified

ICD-10-CM

No Prior Auth Required

No active coverage policies found for this code (low confidence)

Documentation that the patient's diagnosis meets one of the covered indications (e.g., chronic neck pain or chronic headache with minimum 12 weeks duration where applicable).
Documentation of duration of symptoms when chronicity is required (policy explicitly requires minimum 12 weeks duration for chronic neck pain and chronic headache).
Documentation of clinical response: if no clinical benefit after four weeks of acupuncture, the treatment plan should be reevaluated; further treatment is not medically necessary if the member does not demonstrate meaningful improvement in symptoms.
Provider credentialing/license documentation showing the acupuncture is administered by a health care provider practicing within the scope of his/her license (and, where applicable by specific plans, documentation that provider is a legally qualified physician practicing within scope of license).

ANTHEM-LAB.00045, Selected Tests for the Evaluation and Management of Infertility

ANTHEM-CG-LAB-20, Thyroid Testing

ANTHEM-CG-SURG-34, Diagnostic Hysteroscopy for Infertility

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

AMBETTER-CG-Preimplantation-Testing-2025.1, Concert Genetic Testing: Preimplantation Genetic Testing

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