Does O90.41 require prior authorization?

No, O90.41 does not require prior authorization (high confidence). Code is covered without prior authorization.

`O90.41` — Hepatorenal syndrome following labor and delivery

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

For CID codes (T38.895*/T43.215*/T43.225*/T50.995*), the medical record must document the specific chemotherapy agent(s) causing the diarrhea and prior antidiarrheal treatments that have been ineffective.
For VIPoma diagnosis codes (C25.4, C26.0, D13.7, D13.91, D13.99), the medical record must document that the patient’s diagnosis is VIPoma.
When code R79.89 is used, the medical record must document the abnormal clinical or laboratory findings that prompted suspicion of VIPoma.
When code R94.7 is used, the medical record must document an abnormal octreotide scan that prompted suspicion of VIPoma.

Octreotide is covered for chemotherapy-induced diarrhea (CID) when claim includes ICD-10-CM codes T38.895A/T38.895D/T38.895S, T43.215A/T43.215D/T43.215S, T43.225A/T43.225D/T43.225S, or T50.995A/T50.995D/T50.995S and the medical record documents the chemotherapy agent(s) causing the CID and prior antidiarrheal treatments that became ineffective.
Octreotide is covered for treatment of VIPoma when claim includes ICD-10-CM codes C25.4, C26.0, D13.7, D13.91, or D13.99 and the medical record documents that the patient’s diagnosis is VIPoma.
Octreotide may be considered when ICD-10-CM code R79.89 is submitted if the medical record documents abnormal clinical or laboratory findings that led to suspicion of VIPoma.
Octreotide may be considered when ICD-10-CM code R94.7 is submitted if the medical record documents an abnormal octreotide scan that led to suspicion of VIPoma.
ICD-10-CM Codes that Support Medical Necessity — Group 1 (covered diagnoses): D56.1 - Beta thalassemia
ICD-10-CM Codes that Support Medical Necessity — Group 1 (covered diagnoses): D57.02 - Hb-SS disease with splenic sequestration

A57198 — Billing and Coding: Serum Magnesium

A56531 — Billing and Coding: Octreotide Acetate for Injectable Suspension (Sandostatin LAR Depot)

A57189 — Billing and Coding: Serum Magnesium

L33438 — Octreotide Acetate for Injectable Suspension (Sandostatin LAR Depot)

L36700 — Serum Magnesium

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