Does K94.29 require prior authorization?

No, K94.29 does not require prior authorization (high confidence). Code is covered without prior authorization.

`K94.29` — Other complications of gastrostomy

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

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.
Every page of the record must be legible and include appropriate patient identification information (e.g., 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.

Esophagogastroduodenoscopy (EGD) is covered when it meets the reasonable and necessary requirements specified in Local Coverage Determination L33583.
EGD is covered for persistent upper abdominal distress (e.g., gastroesophageal reflux disease) that continues despite an appropriate trial of symptomatic therapy.
EGD is covered for upper abdominal distress accompanied by a short history of concerning signs or symptoms such as weight loss, anorexia, vomiting, or NSAID/other gastric irritant intake.
EGD is covered for patients older than 40 years who have a significant history of heartburn that recurs after a course of symptomatic therapy.
EGD is covered for patients with dysphagia or odynophagia.
EGD is covered for persistent, unexplained vomiting.

A57063 — Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy

J09

L33583 — Diagnostic and Therapeutic Esophagogastroduodenoscopy

J09

ANTHEM-CG-LAB-21 — CG-LAB-21 Serum Iron Testing

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

L34415 — CT of the Abdomen and Pelvis

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