K03.89 — Other specified diseases of hard tissues of teeth
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- None specified in the document. (The CPB does not provide explicit documentation requirements such as required medical records, test results, or prior authorization criteria.)
Key Coverage Criteria
- Xerostomia (dry mouth) — This Clinical Policy Bulletin addresses xerostomia: selected treatments. (No explicit "Covered Indications" section or explicit covered interventions are provided in the document.)
1 Active Policy
AETNA-CPB-0302 — Xerostomia: Selected Treatments
Related Codes
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