Does I97.790 require prior authorization?

No, I97.790 does not require prior authorization (high confidence). Covered without prior authorization.

`I97.790`, Other intraoperative cardiac functional disturbances during cardiac surgery

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Medical record documentation must support the specific diagnosis corresponding to one of the listed ICD-10-CM codes and explicitly state that IABP is not expected to be sufficient.
Clinical documentation should indicate the life-threatening nature (e.g., cardiogenic shock, multi-organ failure, or intra/postoperative circulatory collapse) and any supporting hemodynamic or organ-failure data.
Medical record must document diagnosis supporting one of the three life‑threatening situations and cite the relevant ICD‑10‑CM code(s).

Percutaneous endovascular cardiac assist device is covered for cardiogenic shock (ICD-10-CM R57.0) when intraaortic balloon pump (IABP) is not expected to be sufficient.
Percutaneous endovascular cardiac assist device is covered for severe decompensated heart failure with threatening multi-organ failure when documented by one of the ICD-10-CM codes I50.21, I50.23, I50.41, I50.43, I97.110, I97.111, I97.130, or I97.131 and when IABP is not expected to be sufficient.
Percutaneous endovascular cardiac assist device is covered for intraoperative or postoperative circulatory system complications/disturbances documented by ICD-10-CM codes I97.790, I97.791, I97.88, or I97.89 when IABP is not expected to be sufficient.
Percutaneous endovascular cardiac assist device is covered for cardiogenic shock when external counterpulsation (IABP) is not expected to be sufficient.
Percutaneous endovascular cardiac assist device is covered for severe decompensated heart failure with threatening multi-organ failure when external counterpulsation (IABP) is not expected to be sufficient.
Percutaneous endovascular cardiac assist device is covered for intraoperative or postoperative complications/disturbances of the circulatory system when external counterpulsation (IABP) is not expected to be sufficient.

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J18-L34338, Transthoracic Echocardiography (TTE)

J18

NGS-J6-L33577, Transthoracic Echocardiography (TTE)

A56781, Billing and Coding: Transthoracic Echocardiography (TTE)

NOVITAS-JH-L35016, Transesophageal Echocardiography (TEE)

NGS-JK-L33577, Transthoracic Echocardiography (TTE)

NOVITAS-JL-L35016, Transesophageal Echocardiography (TEE)

A56505, Billing and Coding: Transesophageal Echocardiography (TEE)

A59657, Billing and Coding: Artificial Hearts and Percutaneous Endovascular Cardiac Assist Procedures and Devices

CIGNA-0510, Transthoracic Echocardiography in Adults

A53986, Billing and Coding: Percutaneous Ventricular Assist Device

A53988, Billing and Coding: Percutaneous Ventricular Assist Device

A56625, Billing and Coding: Echocardiography

A57306, Billing and Coding: Transthoracic Echocardiography (TTE)

A57326, Billing and Coding: Electrocardiograms