R94.6 — Abnormal results of thyroid function studies
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
- Every page of the medical record must be legible and include appropriate patient identification (e.g., complete name and 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).
Key Coverage Criteria
- Ultrasound of soft tissues of the head and neck is covered when it is reasonable and necessary as defined by Local Coverage Determination L34027.
- Evaluation of abnormalities in the tissues or organs of the head and neck (e.g., palpable masses).
- Evaluation of abnormalities detected on other imaging examinations (e.g., areas of abnormal uptake on radioisotope thyroid scans).
- Ultrasound for patients with a personal or family history of thyroid malignancy.
- Evaluation of suspected regional nodal metastases in patients with proven thyroid carcinoma.
- Follow-up imaging of a lesion or nodule (e.g., after medical suppression therapy).
3 Active Policies
A57029 — Billing and Coding: Ultrasound, Soft Tissues of Head and Neck
J09
L34027 — Ultrasound, Soft Tissues of Head and Neck
J09
CIGNA-0549 — Head and Neck Ultrasound - (0549)
Related Codes
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