N80.40 — Endometriosis of rectovaginal septum, unspecified involvement of vagina
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.
- Claims must be submitted in compliance with the Local Coverage Determination L39387 and applicable billing/coding guidelines.
- When submitting claims with discarded Part B drugs/biologicals from single-use vials or packages, document the discarded amount and reason in the patient’s medical record.
- Use the JW modifier on claims reporting discarded drugs and ensure supporting documentation in the medical record justifies the modifier.
Key Coverage Criteria
- Administration of LHRH analogs is covered when prescribed, dosed, and administered consistent with FDA-approved labeling.
- Administration code 96402 may be billed with HCPCS codes J1950, J9217, J9202, J3315, J1952, and J1954.
- Administration codes 11981, 11982, and 11983 may be billed with HCPCS codes J9219 and J9225.
- 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.
5 Active Policies
ANTHEM-CG-RAD-28 — CG-RAD-28 Transrectal Ultrasonography
A56421 — Billing and Coding: CT of the Abdomen and Pelvis
A59160 — Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs
L39387 — Luteinizing Hormone-Releasing Hormone (LHRH) Analogs
L34415 — CT of the Abdomen and Pelvis
Related Codes
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