Q51.5 — Agenesis and aplasia of cervix
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 validation/assay information when novel tests (FISH, methylation assays, mRNA assays, p16/Ki-67 dual stain) are used: method, probes/markers used, thresholds and interpretation criteria, and correlation with histology.
- The document does not state explicit documentation requirements for coverage or billing.
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.
5 Active Policies
AETNA-CPB-0327 — Infertility
AETNA-CPB-0443 — Cervical Cancer Screening and Diagnosis
AETNA-CPB-0530 — Transvaginal Ultrasonography
A56421 — Billing and Coding: CT of the Abdomen and Pelvis
L34415 — CT of the Abdomen and Pelvis
Related Codes
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