Does I26.95 require prior authorization?

No, I26.95 does not require prior authorization (high confidence). Covered without prior authorization.

`I26.95`, Cement embolism of pulmonary artery without 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 and made available to the contractor upon request.
Every page of the record must be legible and include appropriate patient identification information, including complete name and dates of service.
The documentation 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 use of the selected ICD-10-CM code(s).

CPT code 93355 is used to report transesophageal echocardiography (TEE) performed during transcatheter intracardiac therapies.
When contrast is used for a complete TEE procedure (probe placement, image acquisition, interpretation and report), bill CPT code 93312 (HCPCS C8925 for OPPS billing).
For congenital anomalies, use CPT code 93315 (HCPCS C8926 for OPPS billing) for the complete contrast TEE procedure.
Hospitals should bill echocardiograms without contrast using the applicable Level 1 CPT code descriptors and guidelines.
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).

CGS-J15-L33959, Cardiac Catheterization and Coronary Angiography

J15

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J18-L33959, Cardiac Catheterization and Coronary Angiography

J18

CGS-J18-L34338, Transthoracic Echocardiography (TTE)

J18

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