Does Q71.819 require prior authorization?

No, Q71.819 does not require prior authorization (high confidence). Covered without prior authorization.

`Q71.819`, Congenital shortening of unspecified upper limb

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Documented medical indication for the ultrasound/examination in the medical record (reason for test, clinical question to be answered).
For detailed fetal anatomic examination: documentation of the specific covered indication (eg, SUA on initial imaging; presence of soft sonographic marker(s) with description; abnormal serum aneuploidy screening results; known or suspected fetal anatomic abnormality; prior pregnancy with omphalocele or other recurrent ultrasound-detectable congenital anomaly; pregnancy resulting from ART; maternal obesity with prepregnancy BMI ≥ 30 kg/m2; known/suspected Zika exposure; pregnancy in woman with untreated or inadequately treated syphilis; previous child with DiGeorge syndrome).
When increased nuchal translucency is cited as the indication: documentation of fetal nuchal translucency measurement value (first trimester NT ≥ 3.0 mm qualifies per policy).

ICD-10 B06.00 - B06.9 — Rubella [German measles]
ICD-10 B50.0 - B54 — Malaria
Fetal ultrasound with detailed anatomic examination when there are known or suspected fetal anatomic abnormalities (including abnormalities suggested by history, laboratory abnormalities, or results of limited/standard ultrasound).
Fetal ultrasound with detailed anatomic examination to evaluate the fetus for amniotic band syndrome (amniotic constriction band syndrome).
Fetal ultrasound with detailed anatomic examination to evaluate fetuses with single umbilical artery (SUA).
Fetal ultrasound with detailed anatomic examination to evaluate fetuses with soft sonographic markers of aneuploidy, including: absent or hypoplastic nasal bone; choroid plexus cyst; echogenic bowel; echogenic intracardiac focus; fetal pyelectasis; increased nuchal translucency (fetal nuchal translucency measurement of 3.0 mm or greater in the first trimester); shortened long bones (femur or humerus).

AETNA-CPB-0199, Ultrasound for Pregnancy

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