Does K74.1 require prior authorization?

No, K74.1 does not require prior authorization (high confidence). Code is covered without prior authorization.

`K74.1` — Hepatic sclerosis

ICD-10-CM

No Prior Auth Required

Code is 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.
The patient's medical record must include the ordering provider's assessment as it relates to the patient's complaint for that visit.
Medical records must include relevant medical history and results of pertinent tests/procedures that justify the Vitamin D assay.
All services ordered or rendered to Medicare beneficiaries must be signed and dated; include signed and dated office visit records or operative reports in the record.

Vitamin D assay testing billed to Medicare Part A or Part B MAC is covered when ordered by an authorized provider (physician or state-authorized non-physician) and the service is otherwise consistent with local coverage determination L33996.
A valid ICD-10-CM diagnosis code that best describes the patient's condition prompting the Vitamin D assay must be reported on the claim; for diagnostic tests, report the test result if known, otherwise report the presenting symptoms.
When a referring/ordering provider is required, the referring/ordering provider name and NPI must be reported on the claim.
25-hydroxy vitamin D testing (including fractions, if performed) is covered when deemed reasonable and necessary per Local Coverage Determination L33771.
Vitamin D assay testing is covered when the medical record documents medical necessity for the test, including the clinical reason for testing and any planned repeat testing and frequency.
Vitamin D assay testing is covered when ordered for evaluation of a patient's vitamin D status and billed with a valid ICD-10-CM diagnosis code that best describes the patient's condition.

A57736 — Billing and Coding: Vitamin D Assay Testing

J06

L37535 — Vitamin D Assay Testing

J06

L33771 — Vitamin D; 25 hydroxy, includes fraction(s), if performed

J09

A56841 — Billing and Coding: Vitamin D; 25 hydroxy, includes fraction(s), if performed

J09

A59170

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