Does Q75.9 require prior authorization?

No, Q75.9 does not require prior authorization (high confidence). Covered without prior authorization.

`Q75.9`, Congenital malformation of skull and face bones, unspecified

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

This article provides billing/coding guidelines that complement Local Coverage Determination L34417 for CT of the head; consult LCD L34417 for specific coverage, coding, and documentation requirements.
Upon review by Aetna's Oral and Maxillofacial Surgery (OMS) Unit, distraction osteogenesis may be considered medically necessary for correction of functional impairments accompanying other congenital craniofacial anomalies where it is determined that distraction osteogenesis can uniquely produce a degree of improvement unavailable with other standard techniques. (Documentation of OMS Unit review is implied.)
Documentation that the patient's condition matches one of the listed congenital craniofacial skeletal deformities and that there is a functional impairment to be corrected (e.g., airway obstruction, severe mandibular deficiency >10 mm).

ICD-10 diagnoses listed as covered when selection criteria are met: Q37.0 - Q37.9 (Cleft palate with cleft lip)
ICD-10 diagnoses listed as covered when selection criteria are met: Q67.0 - Q67.4 (Congenital deformities of skull, face and jaw)
ICD-10 diagnoses listed as covered when selection criteria are met: Q75.0 - Q75.9 (Congenital malformation of skull and face bones [includes hemifacial microstomia])
ICD-10 diagnoses listed as covered when selection criteria are met: Q87.0 (Congenital malformation syndromes predominantly affecting facial appearance)
Distraction osteogenesis (distraction histogenesis) medically necessary for the correction of functional impairments accompanying the following congenital craniofacial skeletal deformities:
Cleft lip and palate;

ANTHEM-GL-C159218, CG-OR-PR-04 Cranial Remodeling Bands and Helmets (Cranial Orthoses)

AETNA-CPB-0549, Distraction Osteogenesis for Craniofacial Defects

AETNA-CPB-0697, Intraoperative Neurophysiological Monitoring

A56612, Billing and Coding: CT of the Head

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