Does Q62.0 require prior authorization?

No, Q62.0 does not require prior authorization (high confidence). Covered without prior authorization.

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`Q62.0`, Congenital hydronephrosis

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Medical records must document that the ultrasound was limited to retroperitoneal structures when billing CPT 76770/76775/76776, including images/findings demonstrating limitation to the retroperitoneum.
If the exam was expanded to include organs outside the retroperitoneum, documentation must reflect the expansion and support billing a full or limited abdominal ultrasound (CPT 76700/76705/76706).
Claims and documentation should follow the complementary Local Coverage Determination L34577 and any applicable LCD requirements.
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.

Key Coverage Criteria

Retroperitoneal ultrasound (CPT 76770, 76775, 76776) is covered when the exam is limited solely to retroperitoneal structures.
A full (complete) or limited abdominal ultrasound (CPT 76700, 76705, 76706) is covered when the exam includes organs or structures outside the retroperitoneum or when primary findings involve non-retroperitoneal structures (e.g., gallbladder, liver, spleen, common bile duct).
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).

4 Active Policies

AMBETTER-CP.MP.38, Ultrasound in Pregnancy

AETNA-CPB-0199, Ultrasound for Pregnancy

A55336, Billing and Coding: Retroperitoneal Ultrasound

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

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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).

Q62.0, Congenital hydronephrosis