Does R82.994 require prior authorization?

No, R82.994 does not require prior authorization (high confidence). Covered without prior authorization.

`R82.994`, Hypercalciuria

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Medical records must document that the ultrasound was limited to retroperitoneal structures when billing CPT 76770/76775/76776, including images/findings demonstrating limitation to the retroperitoneum.
If the exam was expanded to include organs outside the retroperitoneum, documentation must reflect the expansion and support billing a full or limited abdominal ultrasound (CPT 76700/76705/76706).
Claims and documentation should follow the complementary Local Coverage Determination L34577 and any applicable LCD requirements.
The patient's medical record must include the ordering provider's assessment as it relates to the patient's complaint for that visit.

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).
Vitamin D assay testing billed to Medicare Part A or Part B MAC is covered when ordered by an authorized provider (physician or state-authorized non-physician) and the service is otherwise consistent with local coverage determination L33996.
A valid ICD-10-CM diagnosis code that best describes the patient's condition prompting the Vitamin D assay must be reported on the claim; for diagnostic tests, report the test result if known, otherwise report the presenting symptoms.
When a referring/ordering provider is required, the referring/ordering provider name and NPI must be reported on the claim.
Measure 25-hydroxyvitamin D for patients with hypercalciuria.

CGS-J15-L33996, Vitamin D Assay Testing

J15

CGS-J18-L33996, Vitamin D Assay Testing

J18

A55336, Billing and Coding: Retroperitoneal Ultrasound

A56798, Billing and Coding: Vitamin D Assay Testing

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