Does K83.1 require prior authorization?

No, K83.1 does not require prior authorization (high confidence). Code is covered without prior authorization.

`K83.1` — Obstruction of bile duct

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.
The patient's medical record must include the ordering provider's assessment as it relates to the patient's complaint for that visit.

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.
Upper gastrointestinal endoscopy (diagnostic or therapeutic) is covered when determined reasonable and necessary per Local Coverage Determination L35350.
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).

L34658 — Vitamin D Assay Testing

J05

A57484 — Billing and Coding: Vitamin D Assay Testing

J05

L35350 — Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)

J12

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

J12

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