Does K74.5 require prior authorization?

No, K74.5 does not require prior authorization (high confidence). Code is covered without prior authorization.

`K74.5` — Biliary cirrhosis, unspecified

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

The submitted medical record must support the selected ICD-10-CM code(s), and the submitted CPT/HCPCS code must accurately describe the service performed.
The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
When billing CPT 84999 for the listed tests, include a note identifying the specific test in the Remarks (Part A) or Narrative (Part B) area of the claim.
All documentation must be maintained in the patient's medical record, be legible, include patient identification (e.g., complete name) and dates of service, and be made available to the contractor upon request.

For tests that currently lack specific CPT codes (functional intracellular analysis and total antioxidant function), bill using CPT 84999 and add a note identifying which test was performed in the Remarks area for Part A claims and the Narrative area for Part B claims.
Coverage and reasonable/necessary determinations for assays for vitamins and metabolic function are governed by LCD L34914 and claims must meet that LCD's requirements to be covered.
This article does not specify clinical indications; refer to LCD L36427 for covered indications for wireless capsule endoscopy.
25-hydroxy vitamin D testing (including fractions, if performed) is covered when deemed reasonable and necessary per Local Coverage Determination L33771.
Esophagogastroduodenoscopy (EGD) is covered when it meets the reasonable and necessary requirements specified in Local Coverage Determination L33583.
Monitored Anesthesia Care (MAC) is medically necessary when the patient has one or more documented diagnoses listed as supporting medical necessity (e.g., F91.9, G97.81, T81.9XXA, T88.8XXA, F79) and the diagnosis is matched to the anesthesia/CPT/HCPCS procedure performed.

A57484 — Billing and Coding: Vitamin D Assay Testing

J05

L34658 — Vitamin D Assay Testing

J05

L37535 — Vitamin D Assay Testing

J06

A57736 — Billing and Coding: Vitamin D Assay Testing

J06

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

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