Does T38.3X5A require prior authorization?

No, T38.3X5A does not require prior authorization (high confidence). Covered without prior authorization.

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`T38.3X5A`, Adverse effect of insulin and oral hypoglycemic [antidiabetic] drugs, initial encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

All documentation must be maintained in the patient's medical record and made available to the contractor upon request; every page must be legible and include appropriate patient identification (e.g., complete name, dates of service).
The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
The medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.

Key Coverage Criteria

Allergy testing is covered when the medical record documents a history indicating the possible presence of allergy and the clinician selected a minimal number of tests/antigens based on patient-specific history and physician examination.
Allergy testing is covered when the medical record documents the test(s) used, the interpretation(s), and objective measurement of reaction size (wheal and erythema in mm) or a standardized in vivo grading system.
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.

20 Active Policies

CGS-J15-L40325, Allergy Diagnostic Testing

J15

CGS-J18-L40325, Allergy Diagnostic Testing

J18

A57473, Billing and Coding: Allergy Testing

WPS-J5-L36402, Allergy Testing

A59915, Billing and Coding: Pharmacogenomic Testing

NGS-J6-L39995, Pharmacogenomic Testing

NGS-J6-L40329, Allergy Diagnostic Testing

WPS-J8-L36402, Allergy Testing

A57531, Billing and Coding: Allergy Testing

A58812, Billing and Coding: Pharmacogenomics Testing

FIRST_COAST-L33261, Allergy Testing

FIRST_COAST-L39073, Pharmacogenomics Testing

NOVITAS-JH-L39063, Pharmacogenomics Testing

NOVITAS-JH-L36241, Allergy Testing

NGS-JK-L40329, Allergy Diagnostic Testing

NGS-JK-L39995, Pharmacogenomic Testing

A56558, Billing and Coding: Allergy Testing

NOVITAS-JL-L39063, Pharmacogenomics Testing

NOVITAS-JL-L36241, Allergy Testing

A58801, Billing and Coding: Pharmacogenomics Testing

`T38.3X5A`, Adverse effect of insulin and oral hypoglycemic [antidiabetic] drugs, initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

T38.3X5A, Adverse effect of insulin and oral hypoglycemic [antidiabetic] drugs, initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`T38.3X5A`, Adverse effect of insulin and oral hypoglycemic [antidiabetic] drugs, initial encounter