Does O28.3 require prior authorization?

No, O28.3 does not require prior authorization (high confidence). Covered without prior authorization.

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`O28.3`, Abnormal ultrasonic finding on antenatal screening of mother

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

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.
Claims must include at least one of the specified ICD-10 diagnosis codes on the claim to support Zika-related test billing.
Laboratories must have and make available their FDA Emergency Use Authorization (EUA) for the respective test upon Noridian request.
PRNT confirmatory testing, if indicated, is performed by CDC or CDC-designated labs and the PRNT test result/process is not billed to Medicare (do not submit PRNT claims).

Key Coverage Criteria

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.
Bill Dengue rRT-PCR using CPT 87798 when Dengue testing is ordered and the claim includes at least one of the listed ICD-10 diagnosis codes.
Bill Chikungunya rRT-PCR using CPT 87798 when Chikungunya testing is ordered and the claim includes at least one of the listed ICD-10 diagnosis codes.
If both Dengue and Chikungunya rRT-PCR testing are performed on the same date of service, bill once using CPT 87801.

3 Active Policies

AMBETTER-CG-Prenatl-Diag-via-Amn-etc.-Preg-Loss-2025.1, Concert Genetic Testing: Prenatal Diagnosis (via Amniocentesis, CVS, or PUBS) and Pregnancy Loss

AMBETTER-CP.MP.38, Ultrasound in Pregnancy

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

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O28.3, Abnormal ultrasonic finding on antenatal screening of mother