Does T38.0X4D require prior authorization?

No, T38.0X4D does not require prior authorization (high confidence). Covered without prior authorization.

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`T38.0X4D`, Poisoning by glucocorticoids and synthetic analogues, undetermined, subsequent 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.

When E/M services are reported with allergy testing, medical documentation of the separately identifiable E/M service must be present in the medical record and modifier -25 must be used.

Part B providers must indicate the actual number of tests (one unit per antigen/test) in Box 24G of Form CMS-1500 (paper) or in the service field on EMC claims; the number of tests must also be shown on the claim for MPFSDB payment.

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).
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.

4 Active Policies

WPS-J5-L36402, Allergy Testing

A57473, Billing and Coding: Allergy Testing

WPS-J8-L36402, Allergy Testing

A56625, Billing and Coding: Echocardiography

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T38.0X4D, Poisoning by glucocorticoids and synthetic analogues, undetermined, subsequent encounter