Does M30.3 require prior authorization?

No, M30.3 does not require prior authorization (low confidence). No active coverage policies found for this code.

`M30.3`, Mucocutaneous lymph node syndrome [Kawasaki]

ICD-10-CM

No Prior Auth Required

No active coverage policies found for this code (low confidence)

The medical record must contain documentation fully supporting medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Each echocardiography service requires a formal written report with interpretation retained in the record and copies of image documentation (paper or electronic) available for review.
A complete study must include M-mode and/or 2D measurements of LV end-diastolic diameter, LV end-systolic diameter, LV wall thickness, left atrial diameter, aortic valve excursion, and a qualitative description of LV function, or valid substitutes such as LV volumes, ejection fraction, and mass.
Doppler interrogation must state the modes used and provide both qualitative and quantitative information.

Transthoracic echocardiography (TTE) is covered when the patient's medical record documents medical necessity consistent with the LCD indications for TTE.
Contrast (contrast-enhanced) echocardiography is covered when conventional echocardiographic studies were inconclusive and contrast enhancement is needed to complete diagnostic evaluation.
Repeat echocardiographic studies are covered to monitor changes in cardiac structure or function when there is a change in clinical status or when disease progression is suspected.
IVIG is covered only for indications specified as covered in the related Local Coverage Determination (LCD) and when medical necessity criteria in that LCD are met.
Non-invasive peripheral arterial vascular studies are covered when the study results will be used in the clinical management of the patient and the medical necessity is documented in the medical record.
One preoperative non-invasive vascular scan for bypass surgery is reasonable and covered to guide surgical planning.

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J15-L35891, Intravenous Immune Globulin

J15

CGS-J18-L35891, Intravenous Immune Globulin

J18

CGS-J18-L34338, Transthoracic Echocardiography (TTE)

J18

A57554

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