Does N53.8 require prior authorization?

No, N53.8 does not require prior authorization (high confidence). Code is covered without prior authorization.

`N53.8` — Other male sexual dysfunction

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

The ordering physician/nonphysician practitioner must state the clinical indication and medical necessity for the study in the order.
The performing provider must maintain a permanent record of the performed study and interpretation, and must retain a copy of the ordering provider’s order and the test results.
The report must describe the studies performed, note any contrast media or radiopharmaceuticals used, record any significant patient reactions or complications, and compare with prior relevant imaging.
Variations from normal size must be documented with measurements and the report should address specific clinical questions or explain why questions cannot be answered.

Non‑invasive abdominal/visceral vascular studies are covered when the test results will be used to directly inform or change the patient's clinical management.
A preoperative non‑invasive abdominal/visceral vascular study is covered as reasonable and necessary for patients undergoing bypass surgery (one preoperative scan considered reasonable).
Medically necessary follow‑up non‑invasive abdominal/visceral vascular studies after angioplasty are covered as indicated by the vascular distribution treated.
Non‑invasive abdominal/visceral vascular studies performed in the inpatient hospital (place of service 21) or emergency room (place of service 23) are permitted and are not subject to the routine once‑per‑year outpatient limitation.
Duplex scanning is covered only when it meets the reasonable and necessary requirements specified in Local Coverage Determination L33674.
Duplex scanning is covered to evaluate suspected chronic intestinal ischemia in patients with postprandial epigastric or periumbilical pain lasting 1–3 hours and associated weight loss from decreased oral intake.

A57591 — Billing and Coding: Non-Invasive Abdominal / Visceral Vascular Studies

J05

L35755 — Non-Invasive Abdominal / Visceral Vascular Studies

J05

A57636 — Billing and Coding: Duplex Scanning

J09

L33674 — Duplex Scanning

J09

ANTHEM-CG-LAB-26

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