Does T43.656A require prior authorization?

No, T43.656A does not require prior authorization (high confidence). Covered without prior authorization.

`T43.656A`, Underdosing of methamphetamines, initial encounter

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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-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).
Patient has a DSM-5 mental disorder diagnosis that is the reason for the ordering physician's treatment or for which the patient was hospitalized.
CPT code 86003 (RAST type test) is covered when billed for diagnostic testing, subject to the stated annual frequency limit.
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.

CGS-J15-L34063, RAST Type Tests

J15

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J18-L34338, Transthoracic Echocardiography (TTE)

J18

CGS-J18-L34063, RAST Type Tests

J18

A57473, Billing and Coding: Allergy Testing

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