K82.8 — Other specified diseases of gallbladder
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- 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.
- When a referring or ordering physician is required, the referring/ordering provider's name and NPI must be reported on the claim.
- For diagnostic tests, report the test result on the claim if known; if the result is not known at time of billing, report the symptoms that prompted the test.
- Diagnosis code(s) on the claim must best describe the patient's condition for which the Vitamin D assay was performed.
Key Coverage Criteria
- Vitamin D assay testing is payable under Medicare Part B when performed in an office (POS 11), independent clinic (POS 49), Federally Qualified Health Center (POS 50), or independent laboratory (POS 81).
- Non-physician practitioners (e.g., nurse practitioners, clinical nurse specialists, physician assistants) may certify, order, and establish the plan of care for Vitamin D assay testing as authorized by State law (outpatient settings other than CORFs).
- 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.
6 Active Policies
A57484 — Billing and Coding: Vitamin D Assay Testing
J05
L34658 — Vitamin D Assay Testing
J05
A57802 — Billing and Coding: Hepatic (Liver) Function Panel
AETNA-CPB-0266 — Cholecystokinin Cholescintigraphy
A56421 — Billing and Coding: CT of the Abdomen and Pelvis
Related Codes
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