N94.89 — Other specified conditions associated with female genital organs and menstrual cycle
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.
- If a specific etiology for FSD is discovered on history, physical, and laboratory examination, the suspected etiology may be treated. ('If a specific etiology for FSD is discovered on history, physical, and laboratory examination, the suspected etiology may be treated.')
- Trials and safety assessments described for drugs/devices frequently included: physical examination, cervical Papanicolaou test, clinical laboratory analyses, and assessment of endometrial thickness and histology (as in the ospemifene Phase III trial).
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.
10 Active Policies
AMBETTER-CP.MP.97 — Testing for Select Genitourinary Conditions
AETNA-CPB-0231 — Grenz Ray Therapy for Skin Disorders
AETNA-CPB-0348 — Recurrent Pregnancy Loss
AETNA-CPB-0441 — Pelvic Congestion Syndrome: Treatments
AETNA-CPB-0530 — Transvaginal Ultrasonography
Related Codes
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