Does T46.904A require prior authorization?

No, T46.904A does not require prior authorization (high confidence). Covered without prior authorization.

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`T46.904A`, Poisoning by unspecified agents primarily affecting the cardiovascular system, undetermined, initial encounter

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.
The medical record must contain documentation fully supporting medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Each echocardiography service requires a formal written report with interpretation retained in the record and copies of image documentation (paper or electronic) available for review.

A complete study must include M-mode and/or 2D measurements of LV end-diastolic diameter, LV end-systolic diameter, LV wall thickness, left atrial diameter, aortic valve excursion, and a qualitative description of LV function, or valid substitutes such as LV volumes, ejection fraction, and mass.

Doppler interrogation must state the modes used and provide both qualitative and quantitative information.

Claims for contrast echocardiography must be supported by documentation that conventional studies were inconclusive and contrast enhancement was necessary.

Key Coverage Criteria

Transthoracic echocardiography (TTE) is covered when the patient's medical record documents medical necessity consistent with the LCD indications for TTE.
Contrast (contrast-enhanced) echocardiography is covered when conventional echocardiographic studies were inconclusive and contrast enhancement is needed to complete diagnostic evaluation.
Repeat echocardiographic studies are covered to monitor changes in cardiac structure or function when there is a change in clinical status or when disease progression is suspected.
An ECG is covered when the result is relevant to the management, diagnosis, or treatment of the patient.
A separate ECG on the same day as a cardiac stress test is payable only when it provides additional clinically necessary information beyond the stress test (e.g., to rule out acute myocardial infarction prior to performing the stress test).
Rhythm ECGs are covered when used to evaluate signs or symptoms suggesting a cardiac rhythm disorder.

11 Active Policies

A57473, Billing and Coding: Allergy Testing

WPS-J5-L36402, Allergy Testing

A56781, Billing and Coding: Transthoracic Echocardiography (TTE)

NGS-J6-L33577, Transthoracic Echocardiography (TTE)

WPS-J8-L36402, Allergy Testing

NOVITAS-JH-L35434, Oximetry Services

NGS-JK-L33577, Transthoracic Echocardiography (TTE)

NOVITAS-JL-L35434, Oximetry Services

A57205, Billing and Coding: Oximetry Services

A56612, Billing and Coding: CT of the Head

A57326, Billing and Coding: Electrocardiograms

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T46.904A, Poisoning by unspecified agents primarily affecting the cardiovascular system, undetermined, initial encounter