Does R64 require prior authorization?

No, R64 does not require prior authorization (high confidence). Code is covered without prior authorization.

`R64`, Cachexia

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

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.
Claims must comply with ICD-10-CM Coding Guidelines and the Local Coverage Determination (LCD) for Hospice The Adult Failure To Thrive Syndrome (L34558) when selecting and reporting the principal hospice diagnosis.
All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service).
The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
The submitted medical record must support the use of the selected ICD-10-CM code(s).

Use only ICD-10-CM diagnosis codes that are valid to report as a principal diagnosis under ICD-10-CM Coding Guidelines when submitting a hospice principal diagnosis.
Esophagogastroduodenoscopy (EGD) is covered when it meets the reasonable and necessary requirements specified in Local Coverage Determination L33583.
No specific clinical indications are listed in this article; follow the Local Coverage Determination (LCD) L39400 for indications for magnesium testing or services.
A group 1 mattress overlay or mattress is considered medically necessary DME when the member meets: Altered sensory perception
A group 2 support surface is considered medically necessary DME when: The member has multiple stage II (partial thickness skin loss) pressure ulcers located on the trunk or pelvis, AND The member has been on a comprehensive ulcer treatment program for at least the past month, which has included the use of an appropriate group 1 support surface, AND The member's ulcers have worsened or remained the same over the past month.
A group 1 mattress overlay or mattress is considered medically necessary DME when the member meets: Limited mobility – i.e., member can not independently make changes in body position significant enough to alleviate pressure

A57063, Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy

FIRST_COAST-L33583, Diagnostic and Therapeutic Esophagogastroduodenoscopy

AETNA-CPB-0430, Pressure Reducing Support Surfaces

A56421, Billing and Coding: CT of the Abdomen and Pelvis

A56679, Billing and Coding: Hospice The Adult Failure To Thrive Syndrome

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