Does Q67.8 require prior authorization?

No, Q67.8 does not require prior authorization (high confidence). Covered without prior authorization.

`Q67.8`, Other congenital deformities of chest

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Maintain all documentation in the patient's medical record and make it available to the contractor upon request; every page must be legible and include appropriate patient identification and dates of service.
Documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing care to the patient.
The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
If the provider performing the TEE is different from the ordering/referring physician, the performing provider must retain hard copy documentation of test results and interpretation and copies of the ordering/referring physician's order.

Coverage of transesophageal echocardiogram (TEE) is determined by the reasonable and necessary clinical criteria in Local Coverage Determination L33756; refer to LCD L33756 for specific covered indications.
Covered ICD-10 diagnoses (listed as covered if selection criteria are met): "B91; E66.2; G12.0-G12.9; G14; G47.31; G47.33; G47.35; G47.36; G47.37; G54.0-G54.9; G55; G70.00-G73.7; G93.31-G93.39; J39.8; J40-J44.9; J47.0-J47.9; J67.0-J67.9; J80; J96.00-J96.92; J98.4; M41.00-M41.9; M96.5; M95.4; Q32.0; Q67.8; R06.00-R06.9; R09.02; R53.0-R53.1; R53.81; R58.83; numerous options for late effect of spinal cord injury (codes not listed due to expanded specificity).
Support of chronic and acute ventilatory failure with noninvasive positive-pressure ventilation (NPPV) delivered by a nasal or facemask (bilevel PAP ventilator).
Restrictive thoracic diseases, including thoracic cage abnormalities (e.g., chest wall deformities, kyphoscoliosis, thoracoplasty) and neuromuscular disorders (e.g., amyotrophic lateral sclerosis (ALS), neuropathies, myopathies, dystrophies, sequelae of polio, spinal cord injury) that cause hypoventilation.
Patients with symptoms attributable to nocturnal hypoventilation and objective findings of nocturnal desaturation (e.g., clinically significant nocturnal hypoxemia defined as oxyhemoglobin saturation ≤88% for at least 5 minutes).
Patients with PaCO2 ≥ 45 mm Hg (consensus panel suggested this as a sufficient indication for NPPV).

FIRST_COAST-L33756, Transesophageal Echocardiogram

A57179, Billing and Coding: Transesophageal Echocardiogram

ANTHEM-CG-DME-47, Noninvasive Home Ventilator Therapy for Respiratory Failure

AMBETTER-CP.MP.242, Pulmonary Function Testing

AMBETTER-CP.MP.99, Wheelchair Seating

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