Does T38.0X1A require prior authorization?

No, T38.0X1A does not require prior authorization (high confidence). Covered without prior authorization.

ICD-10-CM T38.0X1A, Poisoning by glucocorticoids and synthetic analogues, accidental (unintentional), initial encounter | No Prior Auth

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`T38.0X1A`, Poisoning by glucocorticoids and synthetic analogues, accidental (unintentional), initial encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

When a limited or follow-up echocardiogram is performed, document the targeted cardiac problem/region and bill using the appropriate CPT code (93308 or 93321).
If the study is a screening exam, document and bill with the appropriate screening ICD-10 code; document any abnormal findings and use the resulting diagnosis for subsequent billing when applicable.
Document use of ultrasound contrast enhancement and its supplies separately when billed, and do not submit separate claims for diagnostic injection services integral to the contrast procedure.

Follow the Local Coverage Determination L37379 and include documentation sufficient to support medical necessity when multiple imaging studies are billed.

Follow LCD L35434 for reasonable and necessary requirements and supporting medical documentation for oximetry services.

Report overnight oximetry using CPT code 94762 on claims.

Key Coverage Criteria

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).
Echocardiograms performed as part of the CAMZYOS REMS program are covered when billed with modifier KX and all REMS program requirements are met for patients with NYHA Class II–III obstructive hypertrophic cardiomyopathy (I42.1).
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.

10 Active Policies

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J18-L34338, Transthoracic Echocardiography (TTE)

J18

A57473, Billing and Coding: Allergy Testing

WPS-J5-L36402, Allergy Testing

WPS-J8-L36402, Allergy Testing

NOVITAS-JH-L35434, Oximetry Services

A57205, Billing and Coding: Oximetry Services

NOVITAS-JL-L35434, Oximetry Services

A56625, Billing and Coding: Echocardiography

A57306, Billing and Coding: Transthoracic Echocardiography (TTE)

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T38.0X1A, Poisoning by glucocorticoids and synthetic analogues, accidental (unintentional), initial encounter