Does B95.3 require prior authorization?

No, B95.3 does not require prior authorization (high confidence). Covered without prior authorization.

`B95.3`, Streptococcus pneumoniae as the cause of diseases classified elsewhere

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

For reduction mammoplasty, the medical record must include height and weight of the beneficiary.
For reduction mammoplasty, include a clinical evaluation documenting signs and/or symptoms ascribed to macromastia, therapies tried prior to surgery, and responses to those therapies.
For reduction mammoplasty, document severity and impact on health-related quality of life using an accepted breast-specific questionnaire.
Operative report must document the weight of tissue removed from each breast (measured in the operating room) and the pathology report for tissue removed must be included in the record.

Reconstructive plastic surgery is covered when performed for therapeutic purposes such as treatment of severe burns, facial repair following auto trauma, or similar reconstructive/therapeutic surgery.
Reduction mammoplasty is covered when the beneficiary has symptomatic breast hypertrophy (macromastia) with documented severe symptoms and demonstrable adverse impact on health-related quality of life as measured by an accepted breast-specific questionnaire, AND persistent signs/symptoms despite a reasonable trial of conservative therapy.
Acanthamoeba in corneal ulceration
Actinomyces, for identification of actinomyces species in tissue specimens
Adenovirus, to diagnose adenovirus myocarditis, and to diagnose adenovirus infection in immunocompromised hosts, including transplant recipients
Anaplastic lymphoma kinase (ALK) testing as an alternative to FISH for selecting individuals for ALK inhibitor therapy

AMBETTER-CP.MP.242, Pulmonary Function Testing

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

A57221, Billing and Coding: Plastic Surgery

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