Does I25.790 require prior authorization?

No, I25.790 does not require prior authorization (high confidence). Covered without prior authorization.

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`I25.790`, Atherosclerosis of other coronary artery bypass graft(s) with unstable angina pectoris

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Claims should include supporting clinical data: relevant medical history, physical examination findings, other laboratory studies, chest x-ray, and electrocardiography to demonstrate that BNP testing is being used in conjunction with standard diagnostics.
For risk stratification after ischemic events, documentation should indicate timing of BNP measurement relative to onset of ischemic symptoms (obtained in the first few days).
Either total BNP assays or N-terminal (NT-proBNP) assays are acceptable and the assay type should be documented on the claim or in the medical record.

Key Coverage Criteria

BNP testing is reasonable and necessary, when used with other medical data, to distinguish a cardiac cause of acute dyspnea from pulmonary or other non-cardiac causes.
BNP testing may be used to distinguish decompensated congestive heart failure from exacerbation of chronic obstructive pulmonary disease in a symptomatic patient with both chronic CHF and COPD.
BNP testing obtained in the first few days after onset of ischemic symptoms may be used for risk stratification (risk of death, myocardial infarction, or CHF) among patients with acute coronary syndrome, including myocardial infarction (with or without ST changes) and unstable angina.
CCTA may be used to reliably rule out significant coronary artery disease (CAD) in patients with low to intermediate pre-test probability of CAD as an alternative to an imaging stress test.
CCTA may be used in a patient presenting with chest pain syndrome when the clinician has a high degree of suspicion that CAD is high on the differential diagnosis.
CCTA may be used to facilitate management in select patients who have an equivocal stress test or stress imaging result.

20 Active Policies

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

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-J15-L40243, Temporary Nontherapeutic Ambulatory Cardiac Monitoring Devices

J15

CGS-J15-L33960, Cardiovascular Nuclear Medicine

J15

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

J15

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

J15

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

J18

CGS-J18-L33959, Cardiac Catheterization and Coronary Angiography

J18

CGS-J18-L34338, Transthoracic Echocardiography (TTE)

J18

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

J18

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

J18

CGS-J18-L33960, Cardiovascular Nuclear Medicine

J18

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

J18

CGS-J18-L34045, Non-Invasive Vascular Studies

J18

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

WPS-J5-L34636, Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring)

WPS-J5-L34761, Percutaneous Coronary Interventions

WPS-J5-L35490, Category III Codes

`I25.790`, Atherosclerosis of other coronary artery bypass graft(s) with unstable angina pectoris

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

I25.790, Atherosclerosis of other coronary artery bypass graft(s) with unstable angina pectoris

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`I25.790`, Atherosclerosis of other coronary artery bypass graft(s) with unstable angina pectoris