Does P92.01 require prior authorization?

No, P92.01 does not require prior authorization (high confidence). Covered without prior authorization.

`P92.01`, Bilious vomiting of newborn

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Medical records must document the medical necessity of the serum magnesium test, including the signs, symptoms, and/or diagnosis that prompted the test.
Laboratories must maintain the physician's order for the serum magnesium test in their records.
Medical records must contain the serum magnesium lab test results.
When requesting individual consideration through written redetermination, providers must include all relevant medical records and supporting literature.

ICD-10 codes listed as covered for MII-EM (when selection criteria are met): R07.9 (chest pain), R11.10–R11.14 (vomiting), R12 (heartburn), R13.10–R13.14 (dysphagia).
CPT codes covered when selection criteria are met for esophageal pH monitoring: 91034 (nasal catheter pH), 91035 (mucosal attached telemetry pH / Bravo alternative) — (subject to the modality-specific selection criteria noted above).
ICD-10 codes listed as covered for esophageal pH monitoring (when selection criteria are met): J02.0–J02.9 (acute pharyngitis), J04.0 (acute laryngitis), J31.2 (chronic pharyngitis), J37.0 (chronic laryngitis), J45.20–J45.50 (intermittent and persistent asthma, uncomplicated), K21.00–K21.9 (GERD), R05.1–R05.9 (cough), R07.9 (chest pain, unspecified).
CPT codes covered when selection criteria are met for MII / MII-pH: 91037 (nasal catheter intraluminal impedance placement, recording, analysis, interpretation), 91038 (prolonged MII, >1 hour up to 24 hours).
ICD-10 codes listed as covered for MII (when selection criteria are met): K21.00–K21.9 (GERD), R05.1–R05.9 (cough), R06.2 (wheezing), R10.0–R10.13 / R10.30–R10.9 (abdominal pain), R11.11 (vomiting without nausea), R12 (heartburn), R14.0–R14.3 (flatulence), R43.8 (disturbances of smell/taste), R62.50 (poor growth), R63.3 (feeding difficulties).
CPT codes covered when selection criteria are met for MII-EM: 91010 (esophageal motility/manometry), 91037, 91038 (prolonged).

AETNA-CPB-0116, Frenectomy or Frenotomy for Ankyloglossia

AETNA-CPB-0667, Esophageal and Airway pH Monitoring

A57189, Billing and Coding: Serum Magnesium

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