Does Q62.11 require prior authorization?

No, Q62.11 does not require prior authorization (high confidence). Covered without prior authorization.

`Q62.11`, Congenital occlusion of ureteropelvic junction

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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.

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).
Cystometrogram (CPT 51725, 51726) is covered when performed to evaluate detrusor contractions, abnormalities of bladder compliance, measure post-void residual, determine bladder capacity, or detect detrusor sphincter dyssynergia (DSD).
Uroflowmetry (CPT 51736, 51741) is covered when used to measure urine flow rate to evaluate suspected reduced detrusor function (eg, neurologic lesion), obstructive causes (eg, BPH, cystocele), or increased flow suggesting stress urinary incontinence (SUI) or intrinsic sphincter dysfunction (ISD).
Urethral pressure profile studies (CPT 51727) are covered when other noninvasive tests are inconclusive and the study is needed to rule out severe urethral incompetence or for limited applications such as artificial urinary sphincter evaluation.
Stimulus evoked response testing (CPT 51792) is covered when used to evaluate suspected cauda equina syndrome or other indications where this neurophysiologic test is clinically indicated.

CGS-J15-L34056, Urodynamics

J15

CGS-J18-L34056, Urodynamics

J18

A57455, Billing and Coding: Urodynamics

NGS-J6-L33576, Urodynamics

NGS-JK-L33576, Urodynamics

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