Does K80.50 require prior authorization?

No, K80.50 does not require prior authorization (high confidence). Code is covered without prior authorization.

`K80.50` — Calculus of bile duct without cholangitis or cholecystitis without obstruction

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 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.
All documentation must be maintained in the patient’s medical record and made available to the contractor upon request.

Upper gastrointestinal endoscopy (diagnostic or therapeutic) is covered when determined reasonable and necessary per Local Coverage Determination L35350.
CT abdomen is medically necessary to evaluate abdominal pain.
CT abdomen is medically necessary to evaluate known or suspected abdominal masses or fluid collections.
CT abdomen is medically necessary for evaluation of primary or metastatic malignancies in the abdomen.
CT abdomen is medically necessary to evaluate abdominal inflammatory processes.
CT abdomen is medically necessary to evaluate abnormalities of abdominal vascular structures.

L35350 — Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)

J12

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

J12

A56389 — Billing and Coding: Upper Gastrointestinal Endoscopy and Visualization

A56421 — Billing and Coding: CT of the Abdomen and Pelvis

L34434 — Upper Gastrointestinal Endoscopy and Visualization

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