Does I12.0 require prior authorization?

No, I12.0 does not require prior authorization (high confidence). Covered without prior authorization.

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`I12.0`, Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high 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.
ESA therapy is indicated for anemia due to decreased erythropoietin production or relative erythropoietin resistance, e.g., anemia of chronic renal failure or end-stage renal disease (ESRD).

20 Active Policies

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J15-L33959, Cardiac Catheterization and Coronary Angiography

J15

CGS-J15-L40386, Erythropoiesis Stimulating Agents (ESA)

J15

CGS-J15-L34356, Erythropoiesis Stimulating Agents (ESA)

J15

CGS-J18-L34045, Non-Invasive Vascular Studies

J18

CGS-J18-L33959, Cardiac Catheterization and Coronary Angiography

J18

CGS-J18-L34356, Erythropoiesis Stimulating Agents (ESA)

J18

CGS-J18-L40386, Erythropoiesis Stimulating Agents (ESA)

J18

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

WPS-J5-L35998, Non-Coronary Vascular Stents

A56795, Billing and Coding: Erythropoiesis Stimulating Agents (ESAs)

A57590, Billing and Coding: Non-Coronary Vascular Stents

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

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

WPS-J5-L34633, Erythropoiesis Stimulating Agents (ESAs)

NGS-J6-L33557, Cardiac Catheterization and Coronary Angiography

NGS-J6-L40334, Erythropoiesis Stimulating Agents

A52850, Billing and Coding: Cardiac Catheterization and Coronary Angiography

NGS-J6-L40333, Erythropoiesis Stimulating Agents

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

`I12.0`, Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

I12.0, Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`I12.0`, Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease