Does R94.30 require prior authorization?

No, R94.30 does not require prior authorization (high confidence). Covered without prior authorization.

`R94.30`, Abnormal result of cardiovascular function study, unspecified

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

For services requiring a referring/ordering physician, the referring/ordering provider's name and NPI must be reported on the claim.
The patient's medical record must document assessment related to the visit complaint, relevant medical history, results of pertinent tests/procedures, and signed and dated office visit or operative reports for all services ordered or rendered.
Claims must be submitted with ICD-10-CM codes that reflect the patient's condition and reason for the service; claims without ICD-10-CM codes will be returned.
The study requires a formal written interpretive report including clear identifying demographics, the interpreting provider's name, reason for the test, an interpretive report, copies of images, and maintenance of computerized image reconstruction data.

CCT/CCTA is covered when the patient's medical record documents medical necessity consistent with Local Coverage Determination L33947 and the claim is submitted with an appropriate ICD-10-CM diagnosis code reflecting the reason for testing.
Preoperative cardiac stress testing with radionuclide imaging for asymptomatic patients deemed at moderate risk is covered only if the medical record documents at least one of the following: diabetes mellitus with complications; peripheral vascular disease; aortic aneurysm; or cerebrovascular disease.
Follow-up or limited transthoracic echocardiography performed to evaluate a single specified cardiac problem or region must be billed with CPT 93308.
Limited Doppler/follow-up echocardiographic studies (for targeted velocity or gradient assessment) should be billed with CPT 93321 (e.g., tricuspid regurgitant velocity to estimate pulmonary artery systolic pressure or sequential transmitral velocity in mitral stenosis).
Coverage and clinical indications for Cardiac Computed Tomography & Angiography (CCTA) follow the Local Coverage Determination LCD L33423; this billing article provides complementary coding guidance only.
Stress testing (exercise or pharmacological, including stress echocardiography) is covered when the results will potentially affect the patient’s treatment plan.

CGS-J15-L33947, Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA)

J15

CGS-J18-L33947, Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA)

J18

WPS-J5-L35490, Category III Codes

WPS-J5-L39913, Artificial Intelligence Enabled CT Based Quantitative Coronary Topography (AI-QCT)/Coronary Plaque Analysis (AI-CPA)

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