Does D13.7 require prior authorization?

No, D13.7 does not require prior authorization (high confidence). Code is covered without prior authorization.

`D13.7` — Benign neoplasm of endocrine pancreas

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

This billing and coding guidance complements Local Coverage Determination L34434; follow LCD L34434 for clinical coverage criteria and required documentation for claims.
All services billed with unlisted procedure codes must include sufficient medical records and supporting documentation to allow development and medical review.
All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service).

Esophagogastroduodenoscopy (EGD) is covered when it meets the reasonable and necessary requirements specified in Local Coverage Determination L33583.
CPT codes 64400-64530 for peripheral nerve blocks may be reported on the date of surgery when performed for postoperative pain management only if the operative anesthesia is general anesthesia, subarachnoid injection, or epidural injection and the adequacy of intraoperative anesthesia is not dependent on the peripheral nerve block.
Peripheral nerve block services that are separate, medically necessary services which cannot be rendered by the surgeon may be reported if the surgeon documents the reason for referral and the additional services are justified in the medical record.
Vitamin D assay testing is payable under Medicare Part B when performed in an office (POS 11), independent clinic (POS 49), Federally Qualified Health Center (POS 50), or independent laboratory (POS 81).
Non-physician practitioners (e.g., nurse practitioners, clinical nurse specialists, physician assistants) may certify, order, and establish the plan of care for Vitamin D assay testing as authorized by State law (outpatient settings other than CORFs).
Peripheral nerve blocks are covered when they meet the reasonable and necessary requirements specified in LCD L33933.

L34658 — Vitamin D Assay Testing

J05

A57484 — Billing and Coding: Vitamin D Assay Testing

J05

L36850 — Peripheral Nerve Blocks

J06

A57452 — Billing and Coding: Peripheral Nerve Blocks

J06

L39995 — Pharmacogenomic Testing

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