Does Q64.79 require prior authorization?

No, Q64.79 does not require prior authorization (high confidence). Covered without prior authorization.

`Q64.79`, Other congenital malformations of bladder and urethra

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.
Each claim must include ICD-10-CM diagnosis code(s) that accurately reflect the patient's condition and the reason(s) the urodynamic service was performed.
For diagnostic urodynamic tests, report the test result if known; if results are not available at time of claim, report the symptoms that prompted the test.
When a penile pressure cuff is used during a voiding pressure study, report CPT code 55899 and note the non-invasive urodynamic study in the narrative portion of the claim.

Urodynamic testing is covered when medical necessity is documented consistent with the related Local Coverage Determination (LCD) for Urodynamics.
Urodynamic testing is covered for patients with history of radical pelvic surgery.
Urodynamic testing is covered for symptomatic pelvic organ prolapse that extends beyond the hymen.
Urodynamic studies are indicated only after an initial evaluation that includes an appropriate history, physical examination, and urinalysis with microscopy.
Active urinary infection must be treated and effectiveness of treatment observed before performing urodynamic testing.
Urodynamic testing is covered when medically necessary to assist diagnosis if the diagnosis is uncertain and an appropriate treatment plan cannot be developed from the basic diagnostic evaluation.

NGS-J6-L33576, Urodynamics

A57455, Billing and Coding: Urodynamics

NGS-JK-L33576, Urodynamics

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

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