Does I25.759 require prior authorization?

No, I25.759 does not require prior authorization (high confidence). Covered without prior authorization.

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`I25.759`, Atherosclerosis of native coronary artery of transplanted heart with unspecified angina pectoris

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).
Cardiac CT (CCT) or Coronary CT Angiography (CCTA) is covered when the patient's medical record documents medical necessity consistent with the indications and limitations set forth in the attached Local Coverage Determination (LCD).
If a single lesion extends from one target vessel into another but can be revascularized with a single bridging intervention, report it with a single code (CPT 92928).
CPT codes 92920-92944 describe percutaneous revascularization (PCI) for occlusive disease of coronary vessels, including major coronary arteries, coronary artery branches, and coronary artery bypass grafts.

20 Active Policies

CGS-J15-L33960, Cardiovascular Nuclear Medicine

J15

CGS-J15-L33959, Cardiac Catheterization and Coronary Angiography

J15

CGS-J15-L33947, Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA)

J15

CGS-J18-L33960, Cardiovascular Nuclear Medicine

J18

CGS-J18-L33947, Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA)

J18

CGS-J18-L33959, Cardiac Catheterization and Coronary Angiography

J18

WPS-J5-L34761, Percutaneous Coronary Interventions

WPS-J5-L35121, Coronary Computed Tomography Angiography (CCTA)

WPS-J5-L39913, Artificial Intelligence Enabled CT Based Quantitative Coronary Topography (AI-QCT)/Coronary Plaque Analysis (AI-CPA)

WPS-J5-L35490, Category III Codes

A57479, Billing and Coding: Percutaneous Coronary Interventions

A57552, Billing and Coding: Coronary Computed Tomography Angiography (CCTA)

NGS-J6-L33623, Percutaneous Coronary Intervention

NGS-J6-L33577, Transthoracic Echocardiography (TTE)

NGS-J6-L33560, Cardiovascular Nuclear Medicine

NGS-J6-L33559, Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA)

NGS-J6-L33557, Cardiac Catheterization and Coronary Angiography

A56737, Billing and Coding: Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA)

NGS-J6-L39995, Pharmacogenomic Testing

A52850, Billing and Coding: Cardiac Catheterization and Coronary Angiography

`I25.759`, Atherosclerosis of native coronary artery of transplanted heart with unspecified angina pectoris

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

I25.759, Atherosclerosis of native coronary artery of transplanted heart with unspecified angina pectoris

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`I25.759`, Atherosclerosis of native coronary artery of transplanted heart with unspecified angina pectoris