Does R07.0 require prior authorization?

No, R07.0 does not require prior authorization (high confidence). Covered without prior authorization.

`R07.0`, Pain in throat

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Billing and coding guidance in this policy complements and references Local Coverage Determination L34425; claims should be supported per the documentation requirements specified in LCD L34425.
Claims must include a valid ICD-10-CM diagnosis code that best describes the patient's condition; claims without a valid ICD-10-CM code will be returned as incomplete under Section 1833(e).
Hospital inpatient claims must report the principal diagnosis in UB-04 Form Locator 67 and up to eight additional ICD-10-CM codes in FL 67A-67Q; admitting diagnosis is required in FL 69.
Hospital outpatient claims must report the full ICD-10-CM code for the diagnosis chiefly responsible for the outpatient services in FL 67, or the presenting symptom or Z00.00–Z13.9 if no definitive diagnosis.

No specific clinical indications are listed in this billing/coding guidance; coverage determinations for MRI of the head and neck follow Local Coverage Determination L34425.
Outpatient psychiatry and psychology services are payable under Medicare Part B when provided in accepted places of service listed (e.g., office 11, outpatient hospital 22, telehealth in patient's home 10, etc.).
Services of physicians, clinical psychologists, physician assistants, nurse practitioners, and clinical nurse specialists should be billed to the Part B Medicare Administrative Contractor (MAC).
Individual psychotherapy CPT codes must be used when the primary focus of the treatment encounter is psychotherapy.
When the visit is primarily psychotherapy and also includes pharmacological management, bill the appropriate psychotherapy code (which includes E/M) and CPT 90863 for pharmacological management in addition.
For services that require a referring/ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.

CGS-J15-L34353, Outpatient Psychiatry and Psychology Services

J15

CGS-J18-L34353, Outpatient Psychiatry and Psychology Services

J18

ANTHEM-CG-LAB-30, Outpatient Laboratory-based Blood Glucose Testing

ANTHEM-CG-LAB-20, Thyroid Testing

A56729, Billing and Coding: Magnetic Resonance Imaging of the Head and Neck

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