Does R10.10 require prior authorization?

No, R10.10 does not require prior authorization (high confidence). Covered without prior authorization.

`R10.10`, Upper abdominal pain, unspecified

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Medical records must be maintained and available upon request; every page must be legible and include patient identification (e.g., full name, dates of service) and identify the physician or non-physician practitioner responsible for care.
Submitted medical records must support the selected diagnosis code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
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.
Claims and documentation requirements for CPNB are governed by and must follow the Local Coverage Determination L37641 referenced by this guideline.

Regional or local nerve blocks performed as an adjunct to, or as the sole means of, regional/local anesthesia for an operative procedure are not affected by this noncoverage policy (i.e., such intraoperative regional/local anesthesia is allowed).
No specific coverage indications are stated in this billing/coding guideline; refer to Local Coverage Determination L37641 for covered indications for continuous peripheral nerve blocks (CPNB).
Colonoscopy/sigmoidoscopy/proctosigmoidoscopy is covered for surveillance of colonic neoplasia in patients with a history of colorectal cancer or colonic polyps.
A follow-up procedure is covered 1 year after surgery for treatment of colorectal cancer when the patient is identified as high-risk for colon cancer and is eligible for continued screenings.
This article does not specify clinical indications; refer to LCD L36427 for covered indications for wireless capsule endoscopy.
Esophagogastroduodenoscopy (EGD) is covered when it meets the reasonable and necessary requirements specified in Local Coverage Determination L33583.

NGS-J6-L36850, Peripheral Nerve Blocks

NGS-J6-L39226, Multiplex Gastrointestinal Pathogen Panel (GPP) Tests for Acute Gastroenteritis (AGE)

A57452, Billing and Coding: Peripheral Nerve Blocks

A58963, Billing and Coding: Multiplex Gastrointestinal Pathogen Panel (GPP) Tests for Acute Gastroenteritis (AGE)

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