Does I11.0 require prior authorization?

No, I11.0 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

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`I11.0`, Hypertensive heart disease with heart failure

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Documentation Required

The patient's medical record must fully document medical necessity for the cardiac catheterization and support the diagnosis and procedures billed.
Each claim must include ICD-10-CM diagnosis code(s) that accurately reflect the patient's condition and reason for the procedure and these codes must be linked to the CPT procedure codes on the claim.
When a referring/ordering physician is required, the name and NPI of the referring/ordering physician must be reported on the claim; for extra-cardiac angiographic services the treating physician's name and NPI must be submitted in items 17/17a of CMS-1500 or electronic equivalent.

Key Coverage Criteria

Medicare Part B covers the professional component of cardiac catheterization and coronary angiography when performed in hospital inpatient and outpatient facility settings.
Diagnostic cardiac catheterization performed in an office setting (where permitted) is covered under Medicare Part B for both professional and technical components.
Global and technical component procedures are covered under Part B when performed under personal physician supervision in an IDTF, free-standing facility, physician office, or physician-directed clinic (physician present in room for entire procedure).
Bariatric surgery for treatment of co-morbid conditions related to morbid obesity is payable when billed in accordance with CMS Pub 100-03 Medicare National Coverage Determinations Manual, Chapter 1 Part 2 Section 100.1.
Additional diagnoses listed in this local coverage article for Part A procedure codes and the article's listed CPT codes are covered for bariatric surgery to treat co-morbid conditions related to morbid obesity.
MRA is covered to evaluate blood flow in the internal carotid vessels of the head and neck.

20 Active Policies

CGS-J15-L33943, B-type Natriuretic Peptide (BNP) Testing

J15

CGS-J15-L33959, Cardiac Catheterization and Coronary Angiography

J15

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J18-L33943, B-type Natriuretic Peptide (BNP) Testing

J18

CGS-J18-L33959, Cardiac Catheterization and Coronary Angiography

J18

CGS-J18-L34338, Transthoracic Echocardiography (TTE)

J18

A57591, Billing and Coding: Non-Invasive Abdominal / Visceral Vascular Studies

WPS-J5-L35755, Non-Invasive Abdominal / Visceral Vascular Studies

A54923, Billing and Coding: Bariatric Surgery for Treatment of Co-Morbidities Conditions Related to Morbid Obesity

A52850, Billing and Coding: Cardiac Catheterization and Coronary Angiography

NGS-J6-L33633, Magnetic Resonance Angiography (MRA)

NGS-J6-L33577, Transthoracic Echocardiography (TTE)

NGS-J6-L33573, B-type Natriuretic Peptide (BNP) Testing

NGS-J6-L39189, Mass Spectrometry (MS) Testing in Monoclonal Gammopathy (MG)

NGS-J6-L33557, Cardiac Catheterization and Coronary Angiography

A56747, Billing and Coding: Magnetic Resonance Angiography (MRA)

A56781, Billing and Coding: Transthoracic Echocardiography (TTE)

A56826, Billing and Coding: B-type Natriuretic Peptide (BNP) Testing

A58921, Billing and Coding: Mass Spectrometry (MS) Testing in Monoclonal Gammopathy (MG)

WPS-J8-L35755, Non-Invasive Abdominal / Visceral Vascular Studies

`I11.0`, Hypertensive heart disease with heart failure

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

I11.0, Hypertensive heart disease with heart failure

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`I11.0`, Hypertensive heart disease with heart failure