Does I26.04 require prior authorization?

No, I26.04 does not require prior authorization (high confidence). Covered without prior authorization.

`I26.04`, Fat embolism of pulmonary artery with acute cor pulmonale

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

All documentation must be maintained in the patient's medical record, be legible, include complete patient identification and dates of service, and be made available to the contractor upon request.
The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
Images of all relevant areas, both normal and abnormal, should be recorded and stored in a retrievable format (electronic format preferred).

Doppler ultrasound (CPT 93971) is the current standard for preoperative evaluation of venous reflux in patients with chronic venous insufficiency.
CPT 93971 may be reported to represent either a limited bilateral study or a complete unilateral study (use appropriate CPT coding to reflect study extent).
Coverage of transesophageal echocardiogram (TEE) is determined by the reasonable and necessary clinical criteria in Local Coverage Determination L33756; refer to LCD L33756 for specific covered indications.
Non‑invasive abdominal/visceral vascular studies are covered when the test results will be used to directly inform or change the patient's clinical management.
A preoperative non‑invasive abdominal/visceral vascular study is covered as reasonable and necessary for patients undergoing bypass surgery (one preoperative scan considered reasonable).
Medically necessary follow‑up non‑invasive abdominal/visceral vascular studies after angioplasty are covered as indicated by the vascular distribution treated.

CGS-J15-L33959, Cardiac Catheterization and Coronary Angiography

J15

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J18-L34338, Transthoracic Echocardiography (TTE)

J18

CGS-J18-L33959, Cardiac Catheterization and Coronary Angiography

J18

Ask Backwork about documentation requirements, denial risks, or coverage in your state.