Does Q40.0 require prior authorization?

No, Q40.0 does not require prior authorization (high confidence). Code is covered without prior authorization.

`Q40.0`, Congenital hypertrophic pyloric stenosis

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service).
The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
The submitted medical record must support the use of the selected ICD-10-CM code(s).

Esophagogastroduodenoscopy (EGD) is covered when it meets the reasonable and necessary requirements specified in Local Coverage Determination L33583.
I25.810 – I25.89 Other forms of chronic ischemic heart disease
I25.9 Chronic ischemic heart disease, unspecified
Zilver PTX Drug-Eluting Peripheral Stent is considered medically necessary for the primary treatment of femoropopliteal artery disease (footnote).
M30.3 Mucocutaneous lymph node syndrome [Kawasaki]
I25.700 – I25.799 Atherosclerosis of coronary artery bypass graft(s) and coronary artery of transplanted heart with angina pectoris

FIRST_COAST-L33583, Diagnostic and Therapeutic Esophagogastroduodenoscopy

A57063, Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy

AETNA-CPB-0621, Drug-Eluting Stents

AETNA-CPB-0678, Gastric Pacing / Electrical Stimulation and Gastroesophageal Per Oral Endoscopic Myotomy

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