Does N06.9 require prior authorization?

No, N06.9 does not require prior authorization (high confidence). Code is covered without prior authorization.

`N06.9` — Isolated proteinuria with unspecified morphologic lesion

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medical records must document that the ultrasound was limited to retroperitoneal structures when billing CPT 76770/76775/76776, including images/findings demonstrating limitation to the retroperitoneum.
If the exam was expanded to include organs outside the retroperitoneum, documentation must reflect the expansion and support billing a full or limited abdominal ultrasound (CPT 76700/76705/76706).
Claims and documentation should follow the complementary Local Coverage Determination L34577 and any applicable LCD requirements.
Medical record must reflect how the cystatin C test result was used in the patient's plan of care.

Retroperitoneal ultrasound (CPT 76770, 76775, 76776) is covered when the exam is limited solely to retroperitoneal structures.
A full (complete) or limited abdominal ultrasound (CPT 76700, 76705, 76706) is covered when the exam includes organs or structures outside the retroperitoneum or when primary findings involve non-retroperitoneal structures (e.g., gallbladder, liver, spleen, common bile duct).
Cystatin C measurement is covered when medical record documents an adult patient (>=18 years) with a creatinine-based eGFR of 45–59 ml/min/1.73 m2 and no markers of kidney damage.
Cystatin C measurement is covered when the ordering documentation demonstrates that creatinine-based GFR estimates are believed to be inaccurate and more accurate GFR knowledge will affect clinical decision-making or the patient's plan of care.
Retroperitoneal ultrasound is indicated for evaluation of the pancreas for diagnosis and management of retroperitoneal abnormalities.
Retroperitoneal ultrasound is indicated to measure and follow the abdominal aorta, including monitoring patients with aortic aneurysms.

A55336 — Billing and Coding: Retroperitoneal Ultrasound

A57643 — Billing and Coding: Lab: Cystatin C Measurement

L34577 — Retroperitoneal Ultrasound

L37616 — Lab: Cystatin C Measurement

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