Does K90.41 require prior authorization?

No, K90.41 does not require prior authorization (high confidence). Code is covered without prior authorization.

`K90.41` — Non-celiac gluten sensitivity

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

All documentation must be maintained in the patient medical record and made available to the contractor upon request, with every page legible and including patient identification (complete name, dates of service).
The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
The submitted medical record must support the use of the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
Results of the vitamin D testing and the resulting treatment regimen must be documented in the patient's medical record, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures (e.g., progress notes and written laboratory reports).

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.
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).
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 B12 injections are covered only when reasonable and necessary per Local Coverage Determination L33967.

A57484 — Billing and Coding: Vitamin D Assay Testing

J05

L34658 — Vitamin D Assay Testing

J05

A57736 — Billing and Coding: Vitamin D Assay Testing

J06

L37535 — Vitamin D Assay Testing

J06

A57063 — Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy

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