Does B17.2 require prior authorization?

No, B17.2 does not require prior authorization (high confidence). Code is covered without prior authorization.

`B17.2`, Acute hepatitis E

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.
Clinical evidence supporting diagnosis (e.g., laboratory or diagnostic test results, such as pathogen identification by appropriate testing) and medical records showing clinical severity and rationale for inhaled ribavirin therapy.
Records demonstrating treatment regimen and administration details as applicable (the CPB cites recommended dosing regimen: 20 mg/mL Virazole in SPAG-2 unit with continuous aerosol administration 12-18 hours/day for 3-7 days as recommended dosing information from Virazole prescribing information).
No explicit 'Documentation Requirements' section or specific documentation checklist is provided in this CPB.

Ribavirin (Virazole) inhalation medically necessary for the treatment of: Respiratory syncytial virus (RSV) infection in immunosuppressed and high risk children and adults;
Ribavirin (Virazole) inhalation medically necessary for the treatment of: Viral hemorrhagic fever (Crimean-Congo, Ebola, Lassa, and Marburg);
Ribavirin (Virazole) inhalation medically necessary for the treatment of: Rift valley fever and Hantaan, a hanta virus.
FDA-Approved indication: Virazole (ribavirin for inhalation solution, USP) is indicated for the treatment of hospitalized infants and young children with severe lower respiratory tract infections due to RSV.
Covered ICD-10 codes (if selection criteria met): A92.0 - A92.9 (Other mosquito-borne fever [e.g., Rift valley])
Covered ICD-10 codes (if selection criteria met): A96.2

AETNA-CPB-0155, Ribavirin for Inhalation Use

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

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