Does K22.89 require prior authorization?

No, K22.89 does not require prior authorization (high confidence). Code is covered without prior authorization.

`K22.89` — Other specified disease of esophagus

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.
This billing/coding guideline complements LCD L33459 (Computerized Axial Tomography (CT), Thorax); follow the LCD for clinical coverage and any required documentation or prior authorization rules.
All documentation must be maintained in the patient's medical record and made available to the contractor upon request.

Esophagogastroduodenoscopy (EGD) is covered when it meets the reasonable and necessary requirements specified in Local Coverage Determination L33583.
Upper gastrointestinal endoscopy (diagnostic or therapeutic) is covered when determined reasonable and necessary per Local Coverage Determination L35350.
CT thorax is covered for diagnosis and/or staging of neoplastic and hematologic processes arising in or involving the thorax.
CT thorax is covered to evaluate pulmonary, mediastinal, pleural, and chest wall infections and their complications.
CT thorax is covered to detect and characterize mediastinal neoplasms and other mediastinal processes.
CT thorax is covered for assessment of cardiopulmonary failure or insufficiency.

A57063 — Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy

J09

L33583 — Diagnostic and Therapeutic Esophagogastroduodenoscopy

J09

A57414 — Billing and Coding: Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)

J12

L35350 — Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)

J12

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