Does T38.0X5D require prior authorization?

No, T38.0X5D does not require prior authorization (high confidence). Covered without prior authorization.

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`T38.0X5D`, Adverse effect of glucocorticoids and synthetic analogues, subsequent 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.
Intravenous bisphosphonate administration is covered for treatment of osteoporosis when medical record documents need for IV route, including description of treatment failure of oral or self‑administered osteoporosis drugs.
Bisphosphonate therapy is covered for heterotopic ossification when the medical record documents clinical need for treatment and justifies IV administration.
Bisphosphonate therapy is covered for bone metastasis (C79.51 or C79.52) provided the patient's record also contains a diagnosis of the primary malignant neoplasm.
In breast cancer patients receiving adjuvant selective estrogen receptor modulators or aromatase inhibitor therapy, bisphosphonates are covered when billed with an appropriate breast cancer diagnosis code and a bone loss diagnosis code documenting treatment indication.
Allergy testing is covered when the patient has clinically significant allergic symptoms and conservative therapy has failed.

20 Active Policies

CGS-J15-L40325, Allergy Diagnostic Testing

J15

CGS-J18-L40325, Allergy Diagnostic Testing

J18

A57473, Billing and Coding: Allergy Testing

A57630, Billing and Coding: Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF)

WPS-J5-L34648, Bisphosphonate Drug Therapy

WPS-J5-L36402, Allergy Testing

WPS-J5-L38213, Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF)

A56907, Billing and Coding: Bisphosphonate Drug Therapy

NGS-J6-L33591, RAST Type Tests

NGS-J6-L40329, Allergy Diagnostic Testing

A56844, Billing and Coding: RAST Type Tests

WPS-J8-L34648, Bisphosphonate Drug Therapy

WPS-J8-L36402, Allergy Testing

WPS-J8-L38213, Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF)

FIRST_COAST-L33261, Allergy Testing

A57531, Billing and Coding: Allergy Testing

NOVITAS-JH-L36241, Allergy Testing

NOVITAS-JH-L35049, Monitored Anesthesia Care

NGS-JK-L40329, Allergy Diagnostic Testing

NGS-JK-L33591, RAST Type Tests

`T38.0X5D`, Adverse effect of glucocorticoids and synthetic analogues, subsequent encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

T38.0X5D, Adverse effect of glucocorticoids and synthetic analogues, subsequent encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`T38.0X5D`, Adverse effect of glucocorticoids and synthetic analogues, subsequent encounter