Does I97.89 require prior authorization?

No, I97.89 does not require prior authorization (high confidence). Code is covered without prior authorization.

Backwork Sign up free

`I97.89`, Other postprocedural complications and disorders of the circulatory system, not elsewhere classified

ICD-10-CM

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Documentation Required

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).

Key Coverage Criteria

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.

20 Active Policies

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J15-L34062, Dialysis Access Maintenance

J15

CGS-J18-L34062, Dialysis Access Maintenance

J18

CGS-J18-L34338, Transthoracic Echocardiography (TTE)

J18

CGS-J18-L34045, Non-Invasive Vascular Studies

J18

NGS-J6-L33577, Transthoracic Echocardiography (TTE)

A56781, Billing and Coding: Transthoracic Echocardiography (TTE)

FIRST_COAST-L36767, Aortography and peripheral angiography

A57056, Billing and Coding: Aortography and Peripheral Angiography

NOVITAS-JH-L35092, Diagnostic Abdominal Aortography and Renal Angiography

NGS-JK-L33577, Transthoracic Echocardiography (TTE)

A56682, Billing and Coding: Diagnostic Abdominal Aortography and Renal Angiography

NOVITAS-JL-L35092, Diagnostic Abdominal Aortography and Renal Angiography

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

ANTHEM-MP-A050277, ANC.00009 Cosmetic and Reconstructive Services of the Trunk, Groin, and Extremities

ANTHEM-CG-DME-06, Compression Devices for Lymphedema

CIGNA-0510, Transthoracic Echocardiography in Adults

A53986, Billing and Coding: Percutaneous Ventricular Assist Device

A53988, Billing and Coding: Percutaneous Ventricular Assist Device

`I97.89`, Other postprocedural complications and disorders of the circulatory system, not elsewhere classified

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

I97.89, Other postprocedural complications and disorders of the circulatory system, not elsewhere classified

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`I97.89`, Other postprocedural complications and disorders of the circulatory system, not elsewhere classified