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ICD-10-CM R94.6, Abnormal results of thyroid function studies | No Prior Auth

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`R94.6`, Abnormal results of thyroid function studies

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
Every page of the medical record must be legible and include appropriate patient identification (e.g., complete name and dates of service).
The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
The submitted medical record must support the use of the selected ICD-10-CM code(s).

Key Coverage Criteria

Ultrasound of soft tissues of the head and neck is covered when it is reasonable and necessary as defined by Local Coverage Determination L34027.
Ultrasound of head and neck soft tissues is considered medically necessary for an individual with ANY of the following indications:
neoplasm of the head or neck
soft tissue mass of the head or neck
enlarged lymph node that is suspicious for malignancy
thyroid or parathyroid cancer

3 Active Policies

FIRST_COAST-L34027, Ultrasound, Soft Tissues of Head and Neck

J9

A57029, Billing and Coding: Ultrasound, Soft Tissues of Head and Neck

J9

CIGNA-0549, Head and Neck Ultrasound

Related Codes

D09.3(3 policies)K12.2(3 policies)C76.0(3 policies)C77.0(3 policies)D34(3 policies)C73(3 policies)76536(3 policies)R22.0(3 policies)

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The submitted CPT/HCPCS code must accurately describe the ultrasound service performed.

Reimbursement will only be provided if a requested service(s) is submitted in accordance with the relevant criteria outlined in the applicable Coverage Policy, including covered diagnosis and/or procedure code(s).