Does R93.5 require prior authorization?

No, R93.5 does not require prior authorization (high confidence). Covered without prior authorization.

`R93.5`, Abnormal findings on diagnostic imaging of other abdominal regions, including retroperitoneum

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.

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).
MRA is covered to evaluate blood flow in the internal carotid vessels of the head and neck.
MRA of peripheral arteries of the lower extremities is covered to determine the presence and extent of peripheral vascular disease and may substitute for conventional angiography (CA).
MRA is covered for pre-operative evaluation of patients undergoing elective abdominal aortic aneurysm (AAA) repair when it is comparable to CA for determining extent of AAA and evaluating aortoiliac occlusive disease and renal artery pathology necessary for surgical planning.
MRA of the renal arteries and aortoiliac arteries (in the absence of AAA or aortic dissection) is covered when MRA is expected to avoid CA, physician history/physical and standard assessments are insufficient, and obtaining MRA has a high probability of positively affecting patient management.

NGS-J6-L33633, Magnetic Resonance Angiography (MRA)

A56747, Billing and Coding: Magnetic Resonance Angiography (MRA)

FIRST_COAST-L33674, Duplex Scanning

A57636, Billing and Coding: Duplex Scanning

FIRST_COAST-L33583, Diagnostic and Therapeutic Esophagogastroduodenoscopy

A57063, Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy

NOVITAS-JH-L34865, Magnetic Resonance Angiography (MRA)

NGS-JK-L33633, Magnetic Resonance Angiography (MRA)

A56805, Billing and Coding: Magnetic Resonance Angiography (MRA)

NOVITAS-JL-L34865, Magnetic Resonance Angiography (MRA)

AMBETTER-CP.MP.38, Ultrasound in Pregnancy

ANTHEM-CG-LAB-27, Human Chorionic Gonadotropin Testing

ANTHEM-CG-LAB-26, Outpatient Alpha-Fetoprotein Testing

ANTHEM-CG-LAB-28, Prostate Specific Antigen Testing

ANTHEM-CG-SURG-34, Diagnostic Hysteroscopy for Infertility

AETNA-CPB-0199, Ultrasound for Pregnancy

A55336, Billing and Coding: Retroperitoneal Ultrasound

A56389, Billing and Coding: Upper Gastrointestinal Endoscopy and Visualization

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

A56775, Billing and Coding: Magnetic Resonance Angiography