Does I26.99 require prior authorization?

No, I26.99 does not require prior authorization (high confidence). Covered without prior authorization.

`I26.99`, Other pulmonary embolism without acute cor pulmonale

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

The ordering physician/nonphysician practitioner must state the clinical indication and medical necessity for the study in the order.
The performing provider must maintain a permanent record of the performed study and interpretation, and must retain a copy of the ordering provider’s order and the test results.
The report must describe the studies performed, note any contrast media or radiopharmaceuticals used, record any significant patient reactions or complications, and compare with prior relevant imaging.
Variations from normal size must be documented with measurements and the report should address specific clinical questions or explain why questions cannot be answered.

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.
Non‑invasive abdominal/visceral vascular studies performed in the inpatient hospital (place of service 21) or emergency room (place of service 23) are permitted and are not subject to the routine once‑per‑year outpatient limitation.
Non-invasive peripheral venous and hemodialysis access studies are covered when the results will be used to guide the clinical management of the patient.
Duplex scanning and physiologic studies may be performed and reimbursed during the same encounter when physiologic studies are abnormal or when evaluating vascular trauma, thromboembolic events, or aneurysmal disease.

CGS-J15-L33959, Cardiac Catheterization and Coronary Angiography

J15

CGS-J15-L34337, Transesophageal Echocardiography (TEE)

J15

CGS-J15-L40258, MolDX: Genetic Testing for Hereditary Thrombophilia

J15

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

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