Does I21.B require prior authorization?

No, I21.B 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.B`, Myocardial infarction with coronary microvascular dysfunction

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 document medical necessity including relevant medical history, physical examination findings, and results of pertinent diagnostic tests or procedures supporting the clinical diagnosis and specific reason for the study.
All segments of the cardiovascular nuclear medicine service must have a formal interpretation and report documented in the medical record.
The referral/order must include the medical indication for the study and be retained in the patient's medical record.

Key Coverage Criteria

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.
Non-invasive vascular studies (duplex scan, physiologic studies, plethysmography, transcranial Doppler) are covered when ordered by the treating or consulting practitioner and medically necessary to evaluate, diagnose, or manage vascular disease.
Initial autogenous access vessel mapping should be billed with HCPCS codes 93985 or 93986 and is covered when medically necessary for surgical planning.
Subsequent autogenous access mapping may be billed with CPT codes 93970 or 93971 when clinically indicated.

20 Active Policies

CGS-J15-L40244, Temporary Nontherapeutic Ambulatory Cardiac Monitoring Devices

J15

CGS-J15-L40243, Temporary Nontherapeutic Ambulatory Cardiac Monitoring Devices

J15

CGS-J18-L40244, Temporary Nontherapeutic Ambulatory Cardiac Monitoring Devices

J18

CGS-J18-L40243, Temporary Nontherapeutic Ambulatory Cardiac Monitoring Devices

J18

NGS-J6-L33627, Non-Invasive Vascular Studies

NGS-J6-L39995, Pharmacogenomic Testing

NGS-J6-L33623, Percutaneous Coronary Intervention

A56781, Billing and Coding: Transthoracic Echocardiography (TTE)

A56823, Billing and Coding: Percutaneous Coronary Intervention

NGS-J6-L33577, Transthoracic Echocardiography (TTE)

NGS-J6-L33560, Cardiovascular Nuclear Medicine

A56758, Billing and Coding: Non-Invasive Vascular Studies

A59915, Billing and Coding: Pharmacogenomic Testing

A56743, Billing and Coding: Cardiovascular Nuclear Medicine

FIRST_COAST-L34021, Sedimentation Rate, Erythrocyte

FIRST_COAST-L38396, Cardiology Non-emergent Outpatient Stress Testing

FIRST_COAST-L33267, B-Type Natriuretic Peptide (BNP)

FIRST_COAST-L39073, Pharmacogenomics Testing

FIRST_COAST-L39492, Ambulatory Electrocardiograph (AECG) Monitoring

A56952, Billing and Coding: Cardiology Non-emergent Outpatient Stress Testing

`I21.B`, Myocardial infarction with coronary microvascular dysfunction

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

I21.B, Myocardial infarction with coronary microvascular dysfunction

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`I21.B`, Myocardial infarction with coronary microvascular dysfunction