Does R04.0 require prior authorization?

No, R04.0 does not require prior authorization (high confidence). Code is covered without prior authorization.

`R04.0` — Epistaxis

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Claims must meet the reasonable and necessary documentation requirements specified in LCD L35035; include clinical records demonstrating medical necessity per the LCD.
Follow the NCCI Coding Policy Manual (Chapters V and IX) for proper coding; retain documentation supporting compliance with NCCI edits.
When billing services that the LCD does not cover, use the appropriate Medicare modifier and document the basis for billing a non-covered service.
Billing and coding guidance in this policy complements and references Local Coverage Determination L34425; claims should be supported per the documentation requirements specified in LCD L34425.

Coverage for thoracic aortography and carotid, vertebral, and subclavian angiography is determined by Local Coverage Determination L35035; services are covered when reasonable and necessary per that LCD.
No specific clinical indications are listed in this billing/coding guidance; coverage determinations for MRI of the head and neck follow Local Coverage Determination L34425.
Bill HCPCS code G0278 for femoral or iliac angiography performed at the time of coronary angiography.
Aortography and peripheral angiography are covered when reasonable and necessary per Local Coverage Determination L36767 and when documentation supports the selected ICD-10-CM diagnosis and medical necessity.
Reconstructive surgery is covered for abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, involutional defects, or disease when performed to improve function or approximate normal appearance.
Removal of breast implant(s) is covered when the medical record documents a condition that makes removal medically reasonable and necessary.

L39051 — Cosmetic and Reconstructive Surgery

J05

A58774 — Billing and Coding: Cosmetic and Reconstructive Surgery

J05

A57056 — Billing and Coding: Aortography and Peripheral Angiography

J09

L36767 — Aortography and peripheral angiography

J09

A56631

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