Does R94.5 require prior authorization?

No, R94.5 does not require prior authorization (high confidence). Code is covered without prior authorization.

`R94.5` — Abnormal results of liver function studies

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.
The ordering physician/nonphysician practitioner must state the clinical indication and medical necessity for the study in the order.
The performing provider must maintain a permanent record of the performed study and interpretation, and must retain a copy of the ordering provider’s order and the test results.
The report must describe the studies performed, note any contrast media or radiopharmaceuticals used, record any significant patient reactions or complications, and compare with prior relevant imaging.

Non‑invasive abdominal/visceral vascular studies are covered when the test results will be used to directly inform or change the patient's clinical management.
A preoperative non‑invasive abdominal/visceral vascular study is covered as reasonable and necessary for patients undergoing bypass surgery (one preoperative scan considered reasonable).
Medically necessary follow‑up non‑invasive abdominal/visceral vascular studies after angioplasty are covered as indicated by the vascular distribution treated.
Non‑invasive abdominal/visceral vascular studies performed in the inpatient hospital (place of service 21) or emergency room (place of service 23) are permitted and are not subject to the routine once‑per‑year outpatient limitation.
CT abdomen is medically necessary to evaluate abdominal pain.
CT abdomen is medically necessary to evaluate known or suspected abdominal masses or fluid collections.

L35755 — Non-Invasive Abdominal / Visceral Vascular Studies

J05

A57591 — Billing and Coding: Non-Invasive Abdominal / Visceral Vascular Studies

J05

AETNA-CPB-0384 — Magnetic Resonance Cholangiopancreatography

ANTHEM-CG-LAB-35 — CG-LAB-35 Cancer Antigen 19-9 Testing

ANTHEM-CG-LAB-33 — CG-LAB-33 Carcinoembryonic Antigen Testing

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