Does R73.09 require prior authorization?

No, R73.09 does not require prior authorization (high confidence). Covered without prior authorization.

Backwork Sign up free

`R73.09`, Other abnormal glucose

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

This article provides billing, coding and guideline information that complements Local Coverage Determination (LCD) L33431 for HbA1c; refer to LCD L33431 for clinical coverage criteria and specific documentation requirements.
Treatment plan indicating intended number of sessions (up to 35 sessions per course) and justification when repeat treatment is requested.
Documentation that the member has disabling chronic stable angina (New York Heart Association Class III or Class IV angina) per the Appendix (NYHA functional classification).
Documentation that the member is refractory to maximum medical therapy.

Key Coverage Criteria

HCPCS codes covered if selection criteria are met: G0166 External counterpulsation, per treatment session
A course of up to 35 sessions of ECP for members who meet both of the following criteria: Members with disabling chronic stable angina (New York Heart Association Class III or Class IV angina) (see Appendix); and Members are refractory to maximum medical therapy and not readily amenable to surgical intervention such as percutaneous transluminal coronary angioplasty (PTCA) or cardiac bypass due to any of the following: Their condition is inoperable; or They are at high-risk of operative complicat [...]
Repeat courses of ECP for persons with chronic stable angina if all of the following criteria are met: Member meets medical necessity criteria for ECP in Section I.A. above; and Prior ECP has resulted in a sustained improvement in symptoms with: A significant (greater than 25 %) reduction in frequency of anginal symptoms; or Improvement by 1 or more anginal classes; and Three or more months has elapsed from the prior ECP treatment;
ICD-10 codes covered if selection criteria are met: I20.1 - I20.9 Angina pectoris [disabling, refractory to maximum medical therapy and not readily amenable to surgical intervention]
ICD-10 codes covered if selection criteria are met: I25.111 - I25.119 Atherosclerotic heart disease of native coronary artery with angina pectoris
ICD-10 codes covered if selection criteria are met: I25.701 - I25.709 Atherosclerosis of coronary artery bypass graft(s) with angina pectoris

10 Active Policies

CGS-J15-L40198, MolDX: Biomarker Testing for Risk Stratification in Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis

J15

CGS-J15-L40199, MolDX: Biomarker Testing in Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis

J15

CGS-J18-L40198, MolDX: Biomarker Testing for Risk Stratification in Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis

J18

CGS-J18-L40199, MolDX: Biomarker Testing in Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis

J18

Have a follow-up question?

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

Ask Backwork about R73.09 Sign up free

R73.09, Other abnormal glucose