Does R94.8 require prior authorization?

No, R94.8 does not require prior authorization (high confidence). Covered without prior authorization.

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`R94.8`, Abnormal results of function studies of other organs and systems

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

This billing and coding article provides guidelines that complement Local Coverage Determination L34415 for CT of the abdomen and pelvis; consult LCD L34415 for specific coverage indications, limitations, and documentation requirements.
This billing/coding guideline complements LCD L33459 (Computerized Axial Tomography (CT), Thorax); follow the LCD for clinical coverage and any required documentation or prior authorization rules.
A legible medical record must document the condition, clinical findings, relevant prior treatment, and clearly justify the necessity and reasonableness of the lumbar MRI.
The documentation must clearly support the ICD-10-CM code(s) reported on the claim.

Key Coverage Criteria

Initial lumbar MRI is covered when the test is medically reasonable and necessary and the medical record documents clinical rationale and supports the ICD-10-CM code(s) billed.
A second lumbar MRI for the same patient is allowable when documentation shows comparative test results are needed to make a more definitive treatment decision.
Multiple scans of different body areas performed on the same day for the same patient are payable when each scan is reasonable and necessary.
Thyroid function testing is consideredmedically necessaryfor individuals who meet any of the following indications:
For evaluation of signs or symptoms consistent with thyroid disease;or
To evaluate, assess, or monitor confirmed or suspected thyroid disease;or

6 Active Policies

ANTHEM-CG-LAB-20, Thyroid Testing

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

AMBETTER-CG-Multi-Inher-DO.-Intel-Dis.-DD-2025.1, Concert Genetic Testing: Multisystem Inherited Disorders, Intellectual Disability, and Developmental Delay

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

A56580, Billing and Coding: Computerized Axial Tomography (CT), Thorax

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R94.8, Abnormal results of function studies of other organs and systems