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ICD-10-CM B27.99, Infectious mononucleosis, unspecified with other complication | No Prior Auth

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`B27.99`, Infectious mononucleosis, unspecified with other complication

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Key Coverage Criteria

Tonsillectomy is consideredmedically necessaryfor individuals 18 years of age and older who meet one or more of the criteria below:
A history of recurrent acute throat infection with a frequency of at least:Three or more episodes in the previous 6 months;orFour or more episodes in the previous 12 months;andDocumentation in the medical record for each episode of sore throat which includes at least one of the following:Temperature greater than 38.3 Â°C (100.9 Â°F);orCervical adenopathy;orTonsillar exudate or erythema;orPositive test for Group A Ã-hemolytic streptococcus (GABHS);or
Three or more episodes in the previous 6 months;or
Four or more episodes in the previous 12 months;and
Documentation in the medical record for each episode of sore throat which includes at least one of the following:Temperature greater than 38.3 Â°C (100.9 Â°F);orCervical adenopathy;orTonsillar exudate or erythema;orPositive test for Group A Ã-hemolytic streptococcus (GABHS);or
Temperature greater than 38.3 Â°C (100.9 Â°F);or

2 Active Policies

ANTHEM-CG-SURG-113, Tonsillectomy with or without Adenoidectomy for Adults

ANTHEM-CG-LAB-29, Gamma Glutamyl Transferase Testing

Related Codes

D49.0(2 policies)82977(1 policies)A19.9(1 policies)A04.9(1 policies)A06.0(1 policies)A15.0(1 policies)A02.0(1 policies)42826(1 policies)

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