Does A69.20 require prior authorization?

No, A69.20 does not require prior authorization (high confidence). Covered without prior authorization.

`A69.20`, Lyme disease, unspecified

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

When a limited or follow-up echocardiogram is performed, document the targeted cardiac problem/region and bill using the appropriate CPT code (93308 or 93321).
If the study is a screening exam, document and bill with the appropriate screening ICD-10 code; document any abnormal findings and use the resulting diagnosis for subsequent billing when applicable.
Document use of ultrasound contrast enhancement and its supplies separately when billed, and do not submit separate claims for diagnostic injection services integral to the contrast procedure.
Follow the Local Coverage Determination L37379 and include documentation sufficient to support medical necessity when multiple imaging studies are billed.

Follow-up or limited transthoracic echocardiography performed to evaluate a single specified cardiac problem or region must be billed with CPT 93308.
Limited Doppler/follow-up echocardiographic studies (for targeted velocity or gradient assessment) should be billed with CPT 93321 (e.g., tricuspid regurgitant velocity to estimate pulmonary artery systolic pressure or sequential transmitral velocity in mitral stenosis).
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.
Myelodysplastic syndromes (MDS): Consideration of iron chelation (once‑daily subcutaneous deferoxamine or oral deferasirox) to decrease iron overload in IPSS Low or Intermediate‑1 patients who have received or are anticipated to receive > 20 RBC transfusions, patients for whom ongoing RBC transfusions are anticipated, and patients with serum ferritin > 2,500 ng/mL (aiming for target ferritin < 1,000 ng/mL as per NCCN guidance).

NGS-J6-L33577, Transthoracic Echocardiography (TTE)

A56781, Billing and Coding: Transthoracic Echocardiography (TTE)

NGS-JK-L33577, Transthoracic Echocardiography (TTE)

AETNA-CPB-0234, Chelation Therapy

AETNA-CPB-0650, Polymerase Chain Reaction Testing: Selected Indications

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