Does Q25.3 require prior authorization?

Yes, Q25.3 requires prior authorization (medium confidence). Conditional coverage; review criteria to confirm PA need.

`Q25.3`, Supravalvular aortic stenosis

ICD-10-CM

Prior Auth Required

Conditional coverage; review criteria to confirm PA need (medium confidence)

Required documentation and claim support (including medical records, diagnostic test results, or prior authorization requirements) are those specified in LCD L35121; follow that LCD for exact documentation elements.
Billing and coding guidance for non-coronary vascular stents is dependent on the coverage indications, limitations, and medical necessity specified in the related Local Coverage Determination (LCD); consult the related LCD for the specific coverage and coding requirements.
The ordering physician/nonphysician practitioner must state the clinical indication and medical necessity for the study in the order.
The performing provider must maintain a permanent record of the performed study and interpretation, and must retain a copy of the ordering provider’s order and the test results.

Coverage indications for Coronary Computed Tomography Angiography (CCTA) are defined in the associated Local Coverage Determination LCD L35121; consult LCD L35121 for specific clinical criteria and medical necessity requirements.
Non‑invasive abdominal/visceral vascular studies are covered when the test results will be used to directly inform or change the patient's clinical management.
A preoperative non‑invasive abdominal/visceral vascular study is covered as reasonable and necessary for patients undergoing bypass surgery (one preoperative scan considered reasonable).
Medically necessary follow‑up non‑invasive abdominal/visceral vascular studies after angioplasty are covered as indicated by the vascular distribution treated.
Non‑invasive abdominal/visceral vascular studies performed in the inpatient hospital (place of service 21) or emergency room (place of service 23) are permitted and are not subject to the routine once‑per‑year outpatient limitation.
CCTA may be used to reliably rule out significant coronary artery disease (CAD) in patients with low to intermediate pre-test probability of CAD as an alternative to an imaging stress test.

CGS-J15-L34337, Transesophageal Echocardiography (TEE)

J15

CGS-J15-L33959, Cardiac Catheterization and Coronary Angiography

J15

CGS-J15-L33947, Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA)

J15

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

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