Does T43.3X5S require prior authorization?

No, T43.3X5S does not require prior authorization (high confidence). Covered without prior authorization.

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`T43.3X5S`, Adverse effect of phenothiazine antipsychotics and neuroleptics, sequela

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

This article provides billing/coding guidelines that complement Local Coverage Determination L34417 for CT of the head; consult LCD L34417 for specific coverage, coding, and documentation requirements.
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.

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).
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 for inhalant allergens is covered when medically necessary; evaluation may include up to 90 prick-puncture tests followed by up to 40 intracutaneous tests if prick/puncture results are negative.
Allergy testing for food sensitivity is covered when medically necessary and may require up to 40 percutaneous tests.
Multitest intracutaneous testing of up to 60 tests may be appropriate in lieu of prick-puncture testing for selected patients (for example, young children, older adults, or needle-phobic individuals).

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

NGS-J6-L40329, Allergy Diagnostic Testing

A56844, Billing and Coding: RAST Type Tests

NGS-J6-L33591, RAST Type Tests

WPS-J8-L36402, Allergy Testing

NOVITAS-JH-L35049, Monitored Anesthesia Care

NGS-JK-L33591, RAST Type Tests

NGS-JK-L40329, Allergy Diagnostic Testing

NOVITAS-JL-L35049, Monitored Anesthesia Care

A57361, Billing and Coding: Monitored Anesthesia Care

A59186, Billing and Coding: Magnesium

ANTHEM-CG-LAB-30, Outpatient Laboratory-based Blood Glucose Testing

A56612, Billing and Coding: CT of the Head

A56625, Billing and Coding: Echocardiography

A57181, Billing and Coding: Allergy Testing

A57189, Billing and Coding: Serum Magnesium

ANTHEM-CG-LAB-25, Outpatient Glycated Hemoglobin and Protein Testing

`T43.3X5S`, Adverse effect of phenothiazine antipsychotics and neuroleptics, sequela

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

T43.3X5S, Adverse effect of phenothiazine antipsychotics and neuroleptics, sequela

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`T43.3X5S`, Adverse effect of phenothiazine antipsychotics and neuroleptics, sequela