Does R10.A1 require prior authorization?

No, R10.A1 does not require prior authorization (high confidence). Covered without prior authorization.

`R10.A1`, Flank pain, right side

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Claims must include the appropriate CPT code (88120 or 88121), 1 unit of service, and an appropriate ICD-10 diagnosis code for the clinical indication.
Laboratories reporting only the technical component should append the TC modifier to CPT 88120 or 88121.
Billing entities must be CLIA certified to submit UroVysion claims and should maintain CLIA certification documentation in the medical record/claims file.
To bill a professional component, the physician must personally read, quantitate, and interpret the probe-stained cells/tissues and document that interpretive work in the medical record.

FISH bladder tumor marker testing using a validated assay (e.g., UroVysion) is covered when performed on urine specimens from persons with hematuria suspected of having bladder cancer to aid initial diagnosis.
FISH bladder tumor marker testing using a validated assay (e.g., UroVysion) is covered for monitoring tumor recurrence in patients previously diagnosed with bladder cancer using urine specimens.
Retroperitoneal ultrasound (CPT 76770, 76775, 76776) is covered when the exam is limited solely to retroperitoneal structures.
A full (complete) or limited abdominal ultrasound (CPT 76700, 76705, 76706) is covered when the exam includes organs or structures outside the retroperitoneum or when primary findings involve non-retroperitoneal structures (e.g., gallbladder, liver, spleen, common bile duct).

A55028, Billing and Coding: Lab: Bladder/Urothelial Tumor Markers

A55336, Billing and Coding: Retroperitoneal Ultrasound

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

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