Does I21.3 require prior authorization?

No, I21.3 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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`I21.3`, ST elevation (STEMI) myocardial infarction of unspecified site

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).
Cardiovascular nuclear medicine testing is reimbursable for risk assessment or re-evaluation in asymptomatic patients or patients with stable symptoms who have known atherosclerotic heart disease on catheterization or SPECT perfusion imaging, provided the patient has not undergone a revascularization procedure within the prior 2 years.
Blood pool scan to assess left ventricular ejection fraction prior to implantation of an implantable cardioverter-defibrillator (ICD) or biventricular pacemaker is covered when the medical record documents the intended plan for device insertion and the test result.
Simultaneous cardiac function studies using the first-pass technique performed with perfusion imaging (CPT 78451-78454) and reported with CPT 78472 and add-on 78496 are covered when the formal report documents that first-pass cardiac function studies were performed and the laboratory is equipped to perform them.

20 Active Policies

CGS-J15-L33959, Cardiac Catheterization and Coronary Angiography

J15

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

J15

CGS-J15-L33960, Cardiovascular Nuclear Medicine

J15

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J18-L33959, Cardiac Catheterization and Coronary Angiography

J18

CGS-J18-L34338, Transthoracic Echocardiography (TTE)

J18

CGS-J18-L34045, Non-Invasive Vascular Studies

J18

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

J18

CGS-J18-L33960, Cardiovascular Nuclear Medicine

J18

WPS-J5-L34761, Percutaneous Coronary Interventions

A57479, Billing and Coding: Percutaneous Coronary Interventions

NGS-J6-L33560, Cardiovascular Nuclear Medicine

NGS-J6-L33557, Cardiac Catheterization and Coronary Angiography

A52850, Billing and Coding: Cardiac Catheterization and Coronary Angiography

A56743, Billing and Coding: Cardiovascular Nuclear Medicine

NGS-J6-L33577, Transthoracic Echocardiography (TTE)

NGS-J6-L33623, Percutaneous Coronary Intervention

A56781, Billing and Coding: Transthoracic Echocardiography (TTE)

A56823, Billing and Coding: Percutaneous Coronary Intervention

`I21.3`, ST elevation (STEMI) myocardial infarction of unspecified site

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

I21.3, ST elevation (STEMI) myocardial infarction of unspecified site

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`I21.3`, ST elevation (STEMI) myocardial infarction of unspecified site