Does Q39.1 require prior authorization?

No, Q39.1 does not require prior authorization (high confidence). Covered without prior authorization.

`Q39.1`, Atresia of esophagus with tracheo-esophageal fistula

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

This billing and coding guidance complements Local Coverage Determination L34434; follow LCD L34434 for clinical coverage criteria and required documentation for claims.
All services billed with unlisted procedure codes must include sufficient medical records and supporting documentation to allow development and medical review.
This billing/coding guideline complements LCD L33459 (Computerized Axial Tomography (CT), Thorax); follow the LCD for clinical coverage and any required documentation or prior authorization rules.
All documentation must be maintained in the patient's medical record and made available to the contractor upon request.

Esophagogastroduodenoscopy (EGD) is covered when it meets the reasonable and necessary requirements specified in Local Coverage Determination L33583.
Upper gastrointestinal endoscopy (diagnostic or therapeutic) is covered when determined reasonable and necessary per Local Coverage Determination L35350.
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).

A57063, Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy

FIRST_COAST-L33583, Diagnostic and Therapeutic Esophagogastroduodenoscopy

NOVITAS-JH-L35350, Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)

NOVITAS-JL-L35350, Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)

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