B15.9 — Hepatitis A without hepatic coma
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is 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.
- CT scans must be performed on CT equipment models that are FDA-known and in full market release phase.
- For Rho(D) immune globulin (Rhogam): documentation of maternal Rh(D) status (unsensitized Rh-negative), paternal Rh status if known, timing (24–28 weeks and postpartum within 72 hours if indicated), and obstetric events prompting administration.
- For transplant CMV prophylaxis with Cytogam: documentation of transplant type, timing relative to transplant (eg, within 72 hours), dosing schedule adherence and serostatus where relevant (noting that many renal transplant studies limited to CMV sero-negative recipients).
Key Coverage Criteria
- CT abdomen is medically necessary to evaluate abdominal pain.
- CT abdomen is medically necessary to evaluate known or suspected abdominal masses or fluid collections.
- CT abdomen is medically necessary for evaluation of primary or metastatic malignancies in the abdomen.
- CT abdomen is medically necessary to evaluate abdominal inflammatory processes.
- CT abdomen is medically necessary to evaluate abnormalities of abdominal vascular structures.
- CT abdomen is medically necessary to evaluate abdominal trauma.
4 Active Policies
A57802 — Billing and Coding: Hepatic (Liver) Function Panel
AETNA-CPB-0544 — Immune Globulins for Post-Exposure Prophylaxis
A56421 — Billing and Coding: CT of the Abdomen and Pelvis
L34415 — CT of the Abdomen and Pelvis
Related Codes
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