Does T36.1X5A require prior authorization?

No, T36.1X5A does not require prior authorization (high confidence). Covered without prior authorization.

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`T36.1X5A`, Adverse effect of cephalosporins and other beta-lactam antibiotics, initial encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

The patient's medical record must contain documentation that fully supports medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Each claim must be submitted with ICD-10-CM code(s) that reflect the patient's condition and indicate the reason(s) the service was performed; claims without ICD-10-CM codes will be returned.
For diagnostic tests, report the test result on the claim if known; if the result is not known at time of claim, report the symptoms that prompted the test.

Key Coverage Criteria

RAST type tests are covered when medically necessary and supported by the related Local Coverage Determination (LCD) and current medical literature or standards of practice.
Allergy testing is covered when the patient has clinically significant allergic symptoms and conservative therapy has failed.
Allergy testing includes performance, evaluation, and reading of cutaneous and mucous membrane tests together with physician history (including immunologic history), physical examination, antigen selection, and interpretation of results.
Standard skin testing is the preferred method when allergy testing is necessary.
When a percutaneous or intracutaneous single test (CPT 95004 or 95024) and sequential/incremental tests (CPT 95017, 95018, 95027) are performed the same day, both code types may be reported only if they are for different allergens or for different dilutions of the same allergen.
CPT code 95060 is payable in office, outpatient hospital (on-campus/off-campus), inpatient hospital, and emergency room settings.

20 Active Policies

CGS-J15-L40325, Allergy Diagnostic Testing

J15

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J15-L34063, RAST Type Tests

J15

CGS-J18-L34063, RAST Type Tests

J18

CGS-J18-L34338, Transthoracic Echocardiography (TTE)

J18

CGS-J18-L40325, Allergy Diagnostic Testing

J18

WPS-J5-L36402, Allergy Testing

A57473, Billing and Coding: Allergy Testing

A56844, Billing and Coding: RAST Type Tests

NGS-J6-L33591, RAST Type Tests

NGS-J6-L40329, Allergy Diagnostic Testing

WPS-J8-L36402, Allergy Testing

FIRST_COAST-L37800, Allergen Immunotherapy

FIRST_COAST-L33261, Allergy Testing

A57531, Billing and Coding: Allergy Testing

A57678, Billing and Coding: Allergen Immunotherapy

NOVITAS-JH-L35049, Monitored Anesthesia Care

NOVITAS-JH-L36240, Allergen Immunotherapy

NOVITAS-JH-L36241, Allergy Testing

NGS-JK-L33591, RAST Type Tests

`T36.1X5A`, Adverse effect of cephalosporins and other beta-lactam antibiotics, initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

T36.1X5A, Adverse effect of cephalosporins and other beta-lactam antibiotics, initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`T36.1X5A`, Adverse effect of cephalosporins and other beta-lactam antibiotics, initial encounter