Does R63.30 require prior authorization?

No, R63.30 does not require prior authorization (high confidence). Code is covered without prior authorization.

`R63.30`, Feeding difficulties, unspecified

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Claims for swallowing studies should include documentation consistent with LCD L33449; this billing guideline is a complement to that LCD and providers should retain medical records supporting the medical necessity of the dysphagia evaluation.
Verify and document compliance with applicable NCCI edits and OPPS packaging rules prior to billing.
Include a valid ICD-10-CM diagnosis code on the claim that best describes the patient's condition for which the heavy metal test was performed.
For diagnostic heavy metal tests, report the test result on the claim if known; if the result is not known, report the symptoms that prompted the test.

Swallowing studies (videofluoroscopic or radiologic studies described by CPT 70370, 70371, or 74230) performed for evaluation or diagnosis of dysphagia are the intended covered service per this billing guideline and LCD L33449.
A lingual frenotomy is consideredmedically necessaryfor the treatment of ankyloglossia-related feeding difficulties whenallthe following criteria (1-4) are met:
Infant is experiencing feeding difficulties (for example, poor latch, lactating parent nipple pain);and
Severity of ankyloglossia confirmed by either of the following:Score of 5 or below on the Tongue-tie and Breastfed Babies (TABBY) assessment tool;orScore of 5 or below on the Bristol Tongue Assessment Tool (BTAT);and
Score of 5 or below on the Tongue-tie and Breastfed Babies (TABBY) assessment tool;or
Score of 5 or below on the Bristol Tongue Assessment Tool (BTAT);and

NGS-J6-L35074, Heavy Metal Testing

A56767, Billing and Coding: Heavy Metal Testing

NGS-JK-L35074, Heavy Metal Testing

ANTHEM-CG-SURG-122, Lingual Frenotomy for Ankyloglossia-Related Feeding Difficulties

ANTHEM-CG-LAB-32, Cancer Antigen 125 Testing

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