Does R11.0 require prior authorization?

No, R11.0 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

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`R11.0`, Nausea

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Documentation Required

This billing and coding guidance complements Local Coverage Determination L34434; follow LCD L34434 for clinical coverage criteria and required documentation for claims.
All services billed with unlisted procedure codes must include sufficient medical records and supporting documentation to allow development and medical review.
All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service).

Key Coverage Criteria

Esophagogastroduodenoscopy (EGD) is covered when it meets the reasonable and necessary requirements specified in Local Coverage Determination L33583.
Parathormone (parathyroid hormone) testing is covered when medical necessity and reasonable-and-necessary criteria specified in Local Coverage Determination L34018 are met.
For renal dialysis facilities submitting claims for parathormone testing, use diagnosis code N18.6 (end stage renal disease).
Upper gastrointestinal endoscopy (diagnostic or therapeutic) is covered when determined reasonable and necessary per Local Coverage Determination L35350.
Allergy testing is covered when the patient has clinically significant allergic symptoms and conservative therapy has failed.
Allergy testing includes performance, evaluation, and reading of cutaneous and mucous membrane tests together with physician history (including immunologic history), physical examination, antigen selection, and interpretation of results.

20 Active Policies

WPS-J5-L36402, Allergy Testing

A57473, Billing and Coding: Allergy Testing

WPS-J8-L36402, Allergy Testing

FIRST_COAST-L33583, Diagnostic and Therapeutic Esophagogastroduodenoscopy

A57122, Billing and Coding: Parathormone (Parathyroid Hormone)

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R11.0, Nausea