Does Q78.4 require prior authorization?

No, Q78.4 does not require prior authorization (high confidence). Covered without prior authorization.

`Q78.4`, Enchondromatosis

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Medical records must include history and physical notes, laboratory results, and documentation of signs and symptoms that warrant the head/neck diagnostic imaging.
Accurate HCPCS/CPT coding must be submitted to differentiate CT and MRI scans from other radiology services and to support coverage determinations.
Documentation and supporting information must be available to Medicare upon request.
Providers should check and apply Correct Coding Initiative (CCI) edits and applicable LCD guidance for correct code combinations before billing.

CT or MRI scans of the head or neck are covered when the medical record documents the scan is reasonable and necessary for diagnostic evaluation.
Coverage requires documentation supporting clinical indication such as history and physical exam findings, laboratory results, and signs or symptoms that justify the diagnostic test.
Use of circular ring external fixation (Ilizarov) for infected nonunions, segmental defects, and complex reconstructions (including combined bone and soft-tissue defects).
The PRECICE intramedullary limb lengthening system for limb lengthening of the tibia and femur for persons with a leg length discrepancy of more than 6 cm
Distraction osteosynthesis refers to a technique in which a limb is gradually lengthened at a controlled rate across the osteotomy site.
Used to treat a wide variety of bone defects including limb lengthening while correcting concurrent associated angular and rotational malalignments, transporting bone segments to fill fracture gaps, and healing non-union fractures.

AETNA-CPB-0220, Distraction Osteosynthesis

A57204, Billing and Coding: MRI and CT Scans of the Head and Neck

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