Does R50.9 require prior authorization?

No, R50.9 does not require prior authorization (high confidence). Covered without prior authorization.

`R50.9`, Fever, unspecified

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

The medical record must contain documentation fully supporting medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Each echocardiography service requires a formal written report with interpretation retained in the record and copies of image documentation (paper or electronic) available for review.
A complete study must include M-mode and/or 2D measurements of LV end-diastolic diameter, LV end-systolic diameter, LV wall thickness, left atrial diameter, aortic valve excursion, and a qualitative description of LV function, or valid substitutes such as LV volumes, ejection fraction, and mass.
Doppler interrogation must state the modes used and provide both qualitative and quantitative information.

Transthoracic echocardiography (TTE) is covered when the patient's medical record documents medical necessity consistent with the LCD indications for TTE.
Contrast (contrast-enhanced) echocardiography is covered when conventional echocardiographic studies were inconclusive and contrast enhancement is needed to complete diagnostic evaluation.
Repeat echocardiographic studies are covered to monitor changes in cardiac structure or function when there is a change in clinical status or when disease progression is suspected.
Respiratory pathogen panel testing is covered when performed in an outpatient Medicare Part B setting using a single biologic specimen collected and tested on a single date of service, and the results are timely and can affect clinical management to improve patient health outcomes.
A panel is defined as all respiratory pathogens tested on that single specimen/date and is covered when ordered as a panel (not as a reflex test).
Molecular syndromic panels for infectious disease pathogen identification are covered when billed with the appropriate proprietary CPT®/PLA code (or acceptable CPT code) and accompanied by supporting ICD-10-CM diagnosis codes documented in the medical record that justify medical necessity.

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

J15

CGS-J15-L39521, Positron Emission Tomography (PET) Scan for Inflammation and Infection

J15

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J18-L39521, Positron Emission Tomography (PET) Scan for Inflammation and Infection

J18

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