Does I50.23 require prior authorization?

No, I50.23 does not require prior authorization (high confidence). Covered without prior authorization.

`I50.23`, Acute on chronic systolic (congestive) heart failure

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Medical documentation supporting reasonable and necessary determination for additional sessions must be included (examples: recent hospital records, office visit notes, dialysis progress notes, MCP visits) when billing 90999 KX.
Follow the WPS GHA LCD L37537 for full documentation requirements and utilization guidelines for frequency of hemodialysis.
For monthly claims submitted with Bill Type 72X and Revenue Codes 0821 and 0881, use one of the permitted line-item billing approaches consistent with the patient's plan of care and supporting documentation.
Append modifier CG to additional sessions when the facility attests the extra treatment is not reasonable and necessary (CG use is for data analysis and will result in denial of payment for that line).

Report each hemodialysis session for ESRD patients on a separate line for claims with dates of service on or after April 1, 2007.
When hemodialysis prescription is 3 sessions per week and each session is furnished, bill each session as CPT 90999 with no modifier for routine conventional dialysis.
For dialysis sessions beyond 3 sessions per week that are reasonable and necessary and supported by medical documentation, bill each additional session as CPT 90999 with modifier KX to be considered for additional payment.
Personal history of sustained ventricular tachycardia (spontaneous or EP-induced) not associated with an acute myocardial infarction and not due to a transient or reversible cause is an indication for ICD implantation.
Personal history of cardiac arrest due to ventricular fibrillation not due to a transient or reversible cause is an indication for ICD implantation.
Patients with prior myocardial infarction and measured left ventricular ejection fraction (LVEF) ≤ 0.30 are indicated for ICD implantation provided they do not have NYHA class IV heart failure, have not had CABG/PCI in the past 3 months, have not had an MI within the past 40 days, and are not candidates for coronary revascularization.

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J15-L37575, Frequency of Hemodialysis

J15

CGS-J15-L33960, Cardiovascular Nuclear Medicine

J15

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

J15

CGS-J15-L33959

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