N35.92 — Unspecified urethral stricture, female
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- 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.
- CT scans must be performed on CT equipment models that are FDA-known and in full market release phase.
- Laboratory values as applicable (e.g., PSA measurements reported in many trials and used as a secondary outcome).
- Imaging/angiographic documentation for PAE (prostatic arterial anatomy identification) and documentation of technical feasibility or reasons for technical failure.
Key Coverage Criteria
- CT abdomen is medically necessary to evaluate abdominal pain.
- CT abdomen is medically necessary to evaluate known or suspected abdominal masses or fluid collections.
- CT abdomen is medically necessary for evaluation of primary or metastatic malignancies in the abdomen.
- CT abdomen is medically necessary to evaluate abdominal inflammatory processes.
- CT abdomen is medically necessary to evaluate abnormalities of abdominal vascular structures.
- CT abdomen is medically necessary to evaluate abdominal trauma.
6 Active Policies
AETNA-CPB-0079 — Benign Prostatic Hyperplasia
AETNA-CPB-0697 — Intraoperative Neurophysiological Monitoring
AETNA-CPB-0784 — Blood and Adipose Product Injections for Selected Indications
ANTHEM-CG-SURG-51 — CG-SURG-51 Outpatient Cystourethroscopy
A56421 — Billing and Coding: CT of the Abdomen and Pelvis
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