Does Z90.5 require prior authorization?

No, Z90.5 does not require prior authorization (high confidence). Covered without prior authorization.

`Z90.5`, Acquired absence of kidney

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.
Staging information (eg, T1a N0 M0 for renal allograft neoplasms in most series) and documentation of metastatic status (absence/presence of distant metastasis) where relevant.
Clinical documentation of surgical ineligibility or high surgical risk when ablation is being considered as an alternative to surgery (eg, PTMC in non-surgical candidates; patients refusing or ineligible for pancreatectomy).
Lesion-specific details where cited in studies: lesion diameter (examples in the literature: PTMC, AMLs range and AML consideration at <4 cm, PNETs ≤2 cm or small NF-PNETs), number of lesions, and proximity to critical structures.

Removal of other primary or metastatic malignant neoplasms, when removal of the neoplasm may be curative, and the member is unable to tolerate surgical resection;
Radiofrequency ablation (RFA) for adrenal gland
Cancer bone pain, management of refractory bone pain in persons with cancer;
Malignant lung masses, in persons who are not candidates for surgical intervention;
Medullary thyroid carcinoma, treatment of distant metastases;
Gastro-intestinal stromal tumors (GIST), treatment of tumors with limited progression;

AETNA-CPB-0492, Radiofrequency Tumor Ablation

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

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