Does R93.89 require prior authorization?

No, R93.89 does not require prior authorization (high confidence). Code is covered without prior authorization.

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`R93.89`, Abnormal findings on diagnostic imaging of other specified body structures

ICD-10-CM

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Documentation Required

The patient's medical record must fully document medical necessity for the cardiac catheterization and support the diagnosis and procedures billed.
Each claim must include ICD-10-CM diagnosis code(s) that accurately reflect the patient's condition and reason for the procedure and these codes must be linked to the CPT procedure codes on the claim.
When a referring/ordering physician is required, the name and NPI of the referring/ordering physician must be reported on the claim; for extra-cardiac angiographic services the treating physician's name and NPI must be submitted in items 17/17a of CMS-1500 or electronic equivalent.

Key Coverage Criteria

Medicare Part B covers the professional component of cardiac catheterization and coronary angiography when performed in hospital inpatient and outpatient facility settings.
Diagnostic cardiac catheterization performed in an office setting (where permitted) is covered under Medicare Part B for both professional and technical components.
Global and technical component procedures are covered under Part B when performed under personal physician supervision in an IDTF, free-standing facility, physician office, or physician-directed clinic (physician present in room for entire procedure).
Transesophageal echocardiography (TEE) is indicated when transthoracic echocardiography (TTE) provides inadequate visualization of cardiac anatomy for structures normally visualized by TTE; report ICD-10-CM R93.1 or R93.8 as the primary diagnosis and the cardiac abnormality as a secondary diagnosis.
TEE is indicated when performed during an open chest (intraoperative) procedure; report ICD-10-CM Z01.89 as the primary diagnosis and the reason for the surgical procedure as the secondary diagnosis.
Use CPT 93315, 93316, or 93317 for evaluation of congenital cardiac anomalies (these codes are reserved for congenital anomalies only).

20 Active Policies

CGS-J15-L34337, Transesophageal Echocardiography (TEE)

J15

CGS-J15-L33959, Cardiac Catheterization and Coronary Angiography

J15

CGS-J18-L34337, Transesophageal Echocardiography (TEE)

J18

CGS-J18-L33959, Cardiac Catheterization and Coronary Angiography

J18

A52850, Billing and Coding: Cardiac Catheterization and Coronary Angiography

NGS-J6-L33557, Cardiac Catheterization and Coronary Angiography

A56747, Billing and Coding: Magnetic Resonance Angiography (MRA)

NGS-J6-L33633, Magnetic Resonance Angiography (MRA)

NGS-J6-L33579, Transesophageal Echocardiography (TEE)

A52868, Billing and Coding: Transesophageal Echocardiography (TEE)

FIRST_COAST-L36767, Aortography and peripheral angiography

A57056, Billing and Coding: Aortography and Peripheral Angiography

NOVITAS-JH-L35035, Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography

NOVITAS-JH-L35434, Oximetry Services

NOVITAS-JH-L34833, Cardiac Rhythm Device Evaluation

NGS-JK-L33579, Transesophageal Echocardiography (TEE)

NGS-JK-L33633, Magnetic Resonance Angiography (MRA)

NGS-JK-L33557, Cardiac Catheterization and Coronary Angiography

NOVITAS-JL-L35035, Thoracic Aortography and Carotid, Vertebral, and Subclavian Angiography

NOVITAS-JL-L34833, Cardiac Rhythm Device Evaluation

`R93.89`, Abnormal findings on diagnostic imaging of other specified body structures

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

R93.89, Abnormal findings on diagnostic imaging of other specified body structures

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`R93.89`, Abnormal findings on diagnostic imaging of other specified body structures