Does O09.93 require prior authorization?

No, O09.93 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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`O09.93`, Supervision of high risk pregnancy, unspecified, third trimester

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

When reporting the JW modifier for discarded drug, the medical record must clearly show the amount administered and the amount wasted.
Medical record must document prior anthracycline therapy for patients receiving albumin-bound paclitaxel, or clearly document a clinical contraindication to anthracycline therapy.
For claims with no discarded amounts from single-dose containers or single-use packages, include the JZ modifier as evidence on the claim (effective July 1, 2023).

Enter specific test verbiage in the claim narrative field: for pre-1/1/2018 Zika rRT-PCR enter 'Zika PCR'; for pre-1/1/2018 Trioplex enter 'Zika Trioplex'; for other tests enter test-appropriate verbiage, using Part A Loop 2300/NTE or Form Locator 80 (CMS 1450) or Part B Loop 2400/SV101-7 or Item 19 (CMS 1500) as applicable.

Key Coverage Criteria

Paclitaxel administered intravenously is covered for antineoplastic (cancer) indications when used in accordance with the FDA-approved labeling.
Off-label uses of paclitaxel are covered when supported by recognized compendia (e.g., NCCN, AHFS, Clinical Pharmacology, Lexi-Drugs, Micromedex) and dosing/frequency follow those compendia.
Albumin-bound paclitaxel (Abraxane) is covered when prior therapy included an anthracycline unless anthracycline therapy is clinically contraindicated.
For dates of service on or after 1/1/2018, bill Zika rRT-PCR using CPT 87662 when testing is ordered and the claim includes at least one of the listed ICD-10 diagnosis codes and testing follows FDA and CDC guidelines.
For dates of service prior to 1/1/2018, bill Zika rRT-PCR using CPT 87999 and enter 'Zika PCR' in the claim narrative field when testing is ordered and the claim includes at least one of the listed ICD-10 diagnosis codes.
For dates of service on or after 1/1/2018, bill Zika virus IgM testing using CPT 86794 when testing is ordered and the claim includes at least one of the listed ICD-10 diagnosis codes.

18 Active Policies

CGS-J15-L39038, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

J15

CGS-J18-L39038, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

J18

A58761, Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

WPS-J5-L39044, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

NGS-J6-L33394, Drugs and Biologicals, Coverage of, for Label and Off-Label Uses

A52450, Billing and Coding: Paclitaxel (e.g., Taxol/Abraxane )

WPS-J8-L39044, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

NGS-JK-L33394, Drugs and Biologicals, Coverage of, for Label and Off-Label Uses

ANTHEM-RAD.00038, Use of 3-D, 4-D or 5-D Ultrasound in Maternity Care

A55326, Billing and Coding: Zika Virus Testing by PCR and ELISA Methods

A58710, Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

A58720, Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

A58747, Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

ANTHEM-CG-LAB-26, Outpatient Alpha-Fetoprotein Testing

ANTHEM-CG-LAB-20, Thyroid Testing

ANTHEM-CG-LAB-30, Outpatient Laboratory-based Blood Glucose Testing

ANTHEM-CG-RAD-26, Maternity Ultrasound in the Outpatient Setting

ANTHEM-CG-LAB-24, Outpatient Urine Culture

`O09.93`, Supervision of high risk pregnancy, unspecified, third trimester

Prior Authorization

Documentation Required

Key Coverage Criteria

18 Active Policies

Related Codes

Have a follow-up question?

O09.93, Supervision of high risk pregnancy, unspecified, third trimester

Prior Authorization

Documentation Required

Key Coverage Criteria

18 Active Policies

Related Codes

Have a follow-up question?

`O09.93`, Supervision of high risk pregnancy, unspecified, third trimester