Does N19 require prior authorization?

No, N19 does not require prior authorization (high confidence). Code is covered without prior authorization.

`N19`, Unspecified kidney failure

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.
Required documentation, prior authorization requirements, and coding instructions for hospice renal care follow the LCD L34559 and local Medicare contractor policies; retain medical records supporting hospice eligibility and renal diagnosis as specified by the LCD.
Verify and document compliance with applicable NCCI edits and OPPS packaging rules prior to billing.
Include a valid ICD-10-CM diagnosis code on the claim that best describes the patient's condition for which the heavy metal test was performed.

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).
Coverage for hospice renal care is determined by the Local Coverage Determination (LCD) L34559; refer to LCD L34559 for specific covered diagnoses and clinical criteria for hospice renal services.
Magnetic resonance angiography (MRA) is covered only when the service meets the reasonable and necessary coverage criteria specified in Local Coverage Determination L34865.
Parathormone (parathyroid hormone) testing is covered when medical necessity and reasonable-and-necessary criteria specified in Local Coverage Determination L34018 are met.
For renal dialysis facilities submitting claims for parathormone testing, use diagnosis code N18.6 (end stage renal disease).

NGS-J6-L35074, Heavy Metal Testing

A56767, Billing and Coding: Heavy Metal Testing

A57122, Billing and Coding: Parathormone (Parathyroid Hormone)

FIRST_COAST-L33941, Routine Foot Care

FIRST_COAST-L34018

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