Does R22.2 require prior authorization?

No, R22.2 does not require prior authorization (high confidence). Code is covered without prior authorization.

`R22.2` — Localized swelling, mass and lump, trunk

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

The medical record must contain documentation fully supporting medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Each echocardiography service requires a formal written report with interpretation retained in the record and copies of image documentation (paper or electronic) available for review.
A complete study must include M-mode and/or 2D measurements of LV end-diastolic diameter, LV end-systolic diameter, LV wall thickness, left atrial diameter, aortic valve excursion, and a qualitative description of LV function, or valid substitutes such as LV volumes, ejection fraction, and mass.
Doppler interrogation must state the modes used and provide both qualitative and quantitative information.

Transthoracic echocardiography (TTE) is covered when the patient's medical record documents medical necessity consistent with the LCD indications for TTE.
Contrast (contrast-enhanced) echocardiography is covered when conventional echocardiographic studies were inconclusive and contrast enhancement is needed to complete diagnostic evaluation.
Repeat echocardiographic studies are covered to monitor changes in cardiac structure or function when there is a change in clinical status or when disease progression is suspected.
Nonvascular extremity ultrasound is covered when medical necessity is documented in the patient's record, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Diagnostic nonvascular extremity ultrasound is covered when the claim includes an ICD-10-CM diagnosis code that best describes the patient's condition and the test result or the symptoms prompting the test are documented.
Esophagogastroduodenoscopy (EGD) is covered when it meets the reasonable and necessary requirements specified in Local Coverage Determination L33583.

L35498 — Removal of Benign Skin Lesions

J05

A57482 — Billing and Coding: Removal of Benign Skin Lesions

J05

L33577 — Transthoracic Echocardiography (TTE)

J06

A56787 — Billing and Coding: Nonvascular Extremity Ultrasound

J06

A56781 — Billing and Coding: Transthoracic Echocardiography (TTE)

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