Q55.22 — Retractile testis
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.
- Documentation of the clinical indication that justifies the ultrasound (e.g., scrotal mass, suspected torsion, acute scrotal pain/swelling, trauma, infertility evaluation, hydrocele, varicocele, non-palpable testes with specific qualifying circumstances such as phenotypically male infant with bilateral non-palpable testes or obese boy where palpation is unreliable).
- For suspected undescended testes: clinical examination findings (e.g., non-palpable testis, laterality) and documentation of why imaging is being performed (for example: to look for gonads/uterus in phenotypically male infant with bilateral non-palpable testes or to inform surgical approach in obese boys).
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.
4 Active Policies
CIGNA-0548 — Scrotal Ultrasound - (0548)
AETNA-CPB-0532 — Scrotal Ultrasonography
A56421 — Billing and Coding: CT of the Abdomen and Pelvis
L34415 — CT of the Abdomen and Pelvis
Related Codes
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