Does Q55.22 require prior authorization?

No, Q55.22 does not require prior authorization (high confidence). Covered without prior authorization.

`Q55.22`, Retractile testis

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.
Documentation of the clinical indication that justifies the ultrasound (e.g., scrotal mass, suspected torsion, acute scrotal pain/swelling, trauma, infertility evaluation, hydrocele, varicocele, non-palpable testes with specific qualifying circumstances such as phenotypically male infant with bilateral non-palpable testes or obese boy where palpation is unreliable).
For suspected undescended testes: clinical examination findings (e.g., non-palpable testis, laterality) and documentation of why imaging is being performed (for example: to look for gonads/uterus in phenotypically male infant with bilateral non-palpable testes or to inform surgical approach in obese boys).

- N50.811 - N50.819 Testicular pain
- N50.82 Scrotal pain [note: policy flags NOT covered for testicular microlithiasis — see limitations]
- P83.5 Congenital hydrocele
- Q53.00 - Q53.9 Undescended and ectopic testicle
- Q55.22 Retractile testis
- Q55.23 Scrotal transposition

CIGNA-0548, Scrotal Ultrasound

AETNA-CPB-0532, Scrotal Ultrasonography

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

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