Does I71.012 require prior authorization?

No, I71.012 does not require prior authorization (high confidence). Covered without prior authorization.

`I71.012`, Dissection of descending thoracic aorta

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Required documentation and claim support (including medical records, diagnostic test results, or prior authorization requirements) are those specified in LCD L35121; follow that LCD for exact documentation elements.
All CCTA studies must be ordered by the treating physician or qualified non-physician practitioner who will use the results in patient management and must be performed under the direct supervision of a physician.
Clinical documentation must justify the indication, include presenting signs/symptoms, pre-test probability, and prior relevant test results (e.g., stress testing, myocardial perfusion imaging, cardiac ultrasound, prior invasive angiography) demonstrating that CCTA will provide new information to guide management.
Technical personnel performing image acquisition must be credentialed (e.g., ARRT or equivalent) and meet applicable state licensure requirements.

Coverage indications for Coronary Computed Tomography Angiography (CCTA) are defined in the associated Local Coverage Determination LCD L35121; consult LCD L35121 for specific clinical criteria and medical necessity requirements.
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.
CCTA may be used to evaluate new or recurrent symptoms in patients with known CAD to assess for progression or exacerbation of underlying coronary disease.
CCTA may be used in patients with prior coronary artery bypass graft (CABG) who present with chest pain or dyspnea to determine graft patency and severity of graft stenoses.

CGS-J15-L33947, Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA)

J15

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J15-L34337, Transesophageal Echocardiography (TEE)

J15

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