Does Z90.79 require prior authorization?

No, Z90.79 does not require prior authorization (high confidence). Code is covered without prior authorization.

`Z90.79` — Acquired absence of other genital organ(s)

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

All services ordered or rendered to Medicare beneficiaries must be signed; providers/suppliers must notify beneficiaries in writing prior to rendering the service if aware the test/item/procedure may not be covered.
A valid ICD-10-CM diagnosis code that best describes the patient's condition must be reported on the claim; claims without a valid ICD-10-CM code will be returned as incomplete under Section 1833(e).
For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
The patient's medical record must include the ordering provider's assessment related to the visit complaint, relevant medical history, results of pertinent tests/procedures, and a signed and dated office visit record or operative report.

Bone mass measurement tests are covered when ordered by the treating physician or a qualified non-physician practitioner authorized by state law.
An initial bone mass measurement is covered (Medicare reimbursement for an initial bone mass measurement may be allowed only once, regardless of sites studied).
A DXA confirmatory test may be performed and covered as a baseline for future monitoring (exception to the 'one type only' rule).
CPT code 77082 (vertebral fracture assessment) is covered when medically necessary, with symptoms documented and when results are anticipated to be used in patient management.
Medicare may cover injectable testosterone pellets (Testopel) for males when used for an FDA‑approved indication and when the service meets Medicare coverage requirements in CMS Medicare Benefit Policy Manual, Chapter 15, §50.4.3.
Injectable testosterone pellet therapy may be used when alternative accepted routes (transdermal, oral, nasal, intramuscular) are clinically inappropriate or insufficient and medical necessity is documented.

AETNA-CPB-0327 — Infertility

UHC-POL-testosterone-replacement-supp-therapy — Testosterone Replacement or Supplementation Therapy

A57132 — Billing and Coding: Bone Mass Measurement

A58828 — Billing and Coding: Treatment of Males with Low Testosterone

A59040 — Billing and Coding: Bone Mass Measurement

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