Does Q51.3 require prior authorization?

No, Q51.3 does not require prior authorization (high confidence). Covered without prior authorization.

`Q51.3`, Bicornate uterus

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

This billing and coding article provides guidelines that complement Local Coverage Determination L34415 for CT of the abdomen and pelvis; consult LCD L34415 for specific coverage indications, limitations, and documentation requirements.
Documented medical indication for the ultrasound/examination in the medical record (reason for test, clinical question to be answered).
For detailed fetal anatomic examination: documentation of the specific covered indication (eg, SUA on initial imaging; presence of soft sonographic marker(s) with description; abnormal serum aneuploidy screening results; known or suspected fetal anatomic abnormality; prior pregnancy with omphalocele or other recurrent ultrasound-detectable congenital anomaly; pregnancy resulting from ART; maternal obesity with prepregnancy BMI ≥ 30 kg/m2; known/suspected Zika exposure; pregnancy in woman with untreated or inadequately treated syphilis; previous child with DiGeorge syndrome).

ICD-10 B06.00 - B06.9 — Rubella [German measles]
ICD-10 B50.0 - B54 — Malaria
Fetal ultrasound with detailed anatomic examination when there are known or suspected fetal anatomic abnormalities (including abnormalities suggested by history, laboratory abnormalities, or results of limited/standard ultrasound).
Fetal ultrasound with detailed anatomic examination to evaluate the fetus for amniotic band syndrome (amniotic constriction band syndrome).
Fetal ultrasound with detailed anatomic examination to evaluate fetuses with single umbilical artery (SUA).
Fetal ultrasound with detailed anatomic examination to evaluate fetuses with soft sonographic markers of aneuploidy, including: absent or hypoplastic nasal bone; choroid plexus cyst; echogenic bowel; echogenic intracardiac focus; fetal pyelectasis; increased nuchal translucency (fetal nuchal translucency measurement of 3.0 mm or greater in the first trimester); shortened long bones (femur or humerus).

AETNA-CPB-0199, Ultrasound for Pregnancy

A56421, Billing and Coding: CT of the Abdomen and Pelvis

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