Does M34.2 require prior authorization?

No, M34.2 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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`M34.2`, Systemic sclerosis induced by drug and chemical

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

Claims for swallowing studies should include documentation consistent with LCD L33449; this billing guideline is a complement to that LCD and providers should retain medical records supporting the medical necessity of the dysphagia evaluation.
When a limited or follow-up echocardiogram is performed, document the targeted cardiac problem/region and bill using the appropriate CPT code (93308 or 93321).
If the study is a screening exam, document and bill with the appropriate screening ICD-10 code; document any abnormal findings and use the resulting diagnosis for subsequent billing when applicable.

Key Coverage Criteria

Swallowing studies (videofluoroscopic or radiologic studies described by CPT 70370, 70371, or 74230) performed for evaluation or diagnosis of dysphagia are the intended covered service per this billing guideline and LCD L33449.
Follow-up or limited transthoracic echocardiography performed to evaluate a single specified cardiac problem or region must be billed with CPT 93308.
Limited Doppler/follow-up echocardiographic studies (for targeted velocity or gradient assessment) should be billed with CPT 93321 (e.g., tricuspid regurgitant velocity to estimate pulmonary artery systolic pressure or sequential transmitral velocity in mitral stenosis).
ESA therapy is indicated for anemia due to decreased erythropoietin production or relative erythropoietin resistance, e.g., anemia of chronic renal failure or end-stage renal disease (ESRD).
ESA therapy is indicated to maintain hematologic targets with typical goals of hematocrit 30.0-36.0% (hemoglobin 10.0-12.0 g/dL) and the medical record should document rationale for dose changes or values outside these ranges.
ESA therapy may be considered for other chronic conditions not specifically addressed by this policy when the patient demonstrates considerable transfusion dependence and anemia-related symptoms and documentation supports reasonable and necessary use.

20 Active Policies

A56795, Billing and Coding: Erythropoiesis Stimulating Agents (ESAs)

WPS-J5-L34633, Erythropoiesis Stimulating Agents (ESAs)

A59434, Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

A59101, Billing and Coding: Off-label Use of Rituximab and Rituximab Biosimilars

NGS-J6-L39297, Off-label Use of Rituximab and Rituximab Biosimilars

A58893, Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

WPS-J8-L34633, Erythropoiesis Stimulating Agents (ESAs)

A57657, Billing and Coding: Sedimentation Rate, Erythrocyte

FIRST_COAST-L33583, Diagnostic and Therapeutic Esophagogastroduodenoscopy

FIRST_COAST-L34021, Sedimentation Rate, Erythrocyte

A59764, Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

A57063, Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy

NOVITAS-JH-L35434, Oximetry Services

NGS-JK-L39297, Off-label Use of Rituximab and Rituximab Biosimilars

A59766, Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

A57205, Billing and Coding: Oximetry Services

NOVITAS-JL-L35434, Oximetry Services

A56625, Billing and Coding: Echocardiography

A59374, Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

A56621, Billing and Coding: Swallowing Studies for Dysphagia

`M34.2`, Systemic sclerosis induced by drug and chemical

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

M34.2, Systemic sclerosis induced by drug and chemical

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`M34.2`, Systemic sclerosis induced by drug and chemical