Does E86.1 require prior authorization?

No, E86.1 does not require prior authorization (high confidence). Covered without prior authorization.

`E86.1`, Hypovolemia

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Each claim must be submitted with ICD-10-CM code(s) that accurately reflect the patient’s condition and indicate the reason(s) the service was performed.
The medical record must include the ordering/referring provider’s name and NPI for services that require a referring/ordering physician.
The patient’s medical record should include the assessment by the ordering provider related to the patient’s complaint, relevant medical history, results of pertinent tests/procedures, and signed and dated office visit or operative reports.
For diagnostic tests, report the test result on the claim when known; otherwise report the symptoms that prompted performance of the test.

Cardiac catheterization and coronary angiography are covered when the medical record documents medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests that support the procedure.
CPT code 93355 is used to report transesophageal echocardiography (TEE) performed during transcatheter intracardiac therapies.
When contrast is used for a complete TEE procedure (probe placement, image acquisition, interpretation and report), bill CPT code 93312 (HCPCS C8925 for OPPS billing).
For congenital anomalies, use CPT code 93315 (HCPCS C8926 for OPPS billing) for the complete contrast TEE procedure.
Hospitals should bill echocardiograms without contrast using the applicable Level 1 CPT code descriptors and guidelines.
Follow-up or limited transthoracic echocardiography performed to evaluate a single specified cardiac problem or region must be billed with CPT 93308.

CGS-J15-L33959, Cardiac Catheterization and Coronary Angiography

J15

CGS-J18-L33959, Cardiac Catheterization and Coronary Angiography

J18

NOVITAS-JH-L35049, Monitored Anesthesia Care

NOVITAS-JH-L35016, Transesophageal Echocardiography (TEE)

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