Does M31.4 require prior authorization?

No, M31.4 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

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`M31.4`, Aortic arch syndrome [Takayasu]

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Documentation Required

A permanent record of the studies performed and the interpretation must be maintained in the medical record.
The report must describe the studies performed and document any contrast media and/or radiopharmaceuticals used.
Any known significant patient reaction or complication must be recorded in the medical record.
Comparison with prior relevant studies must be addressed and both normal and abnormal findings documented with measurements and descriptions of variations from normal.

Key Coverage Criteria

Non-invasive cerebrovascular/vascular studies are covered when the study results will be used to directly inform or change the clinical management of the patient.
Re-evaluation of carotid artery stenosis is covered for patients with diameter reduction >50% who are symptomatic and these patients are normally followed on an annual basis.
Re-evaluation of carotid artery stenosis is covered for patients with diameter reduction >60% who are asymptomatic and these patients are normally followed on an annual basis.
Repeat duplex ultrasound scans are covered at any time for patients who become symptomatic of carotid disease, without regard to scheduled surveillance intervals.
Post–carotid endarterectomy (outside the global period) duplex ultrasonography is covered on the affected (ipsilateral) side at approximately 6 weeks, 6 months, and annually thereafter unless new symptoms develop.
One preoperative Doppler scan for bypass surgery is considered reasonable and necessary and is covered.

20 Active Policies

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J15-L39521, Positron Emission Tomography (PET) Scan for Inflammation and Infection

J15

CGS-J15-L33959, Cardiac Catheterization and Coronary Angiography

J15

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M31.4, Aortic arch syndrome [Takayasu]