Does Z90.49 require prior authorization?

No, Z90.49 does not require prior authorization (high confidence). Covered without prior authorization.

`Z90.49`, Acquired absence of other specified parts of digestive tract

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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.
Policy does not specify detailed documentation requirements.
The policy references "selection criteria" for covered ICD-10 codes (K91.2, Z90.49) but does not provide those selection criteria or explicit required documentation in the text.
Documentation of clinical indicators of failed TPN (examples provided): records showing frequent severe dehydration despite IV fluid supplement plus TPN; documentation of TPN-related complications (e.g., secretory diarrhea, non-constructible GI tract) leading to dehydration.

ICD-10 codes covered if selection criteria are met: Z90.49 (Acquired absence of other specified parts of digestive tract [small or large intestine]).
Aetna considers multidisciplinary intestinal rehabilitation programs medically necessary for persons with parenteral nutrition-dependent intestinal failure.
ICD-10 codes covered if selection criteria are met: K91.2 (Postsurgical malabsorption, not elsewhere classified).
Aetna considers intestinal transplantation medically necessary for persons who have clinical indicators of failed total parenteral nutrition (TPN) when the selection criteria below are met.
Clinical Indicators of Failed TPN: Frequent episodes of severe dehydration despite intravenous fluid supplement in addition to TPN.
Clinical Indicators of Failed TPN: Frequent line infection and sepsis. The development of 2 or more episodes of systemic sepsis due to line infection per year that requires hospitalization indicates failure of TPN therapy. A single episode of line-related fungemia, septic shock and/or acute respiratory distress syndrome are considered indicators of TPN failure.

AETNA-CPB-0342, Intestinal Rehabilitation Programs

AETNA-CPB-0605, Intestinal Transplantation

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

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