Does T46.995S require prior authorization?

No, T46.995S does not require prior authorization (high confidence). Covered without prior authorization.

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`T46.995S`, Adverse effect of other agents primarily affecting the cardiovascular system, sequela

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.
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

WPS-J5-L36402, Allergy Testing

A57473, Billing and Coding: Allergy Testing

NGS-J6-L40329, Allergy Diagnostic Testing

NGS-J6-L33591, RAST Type Tests

A56844, Billing and Coding: RAST Type Tests

WPS-J8-L36402, Allergy Testing

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

A57361, Billing and Coding: Monitored Anesthesia Care

NOVITAS-JL-L36241, Allergy Testing

NOVITAS-JL-L35049, Monitored Anesthesia Care

A56558, Billing and Coding: Allergy Testing

A59186, Billing and Coding: Magnesium

A57181, Billing and Coding: Allergy Testing

`T46.995S`, Adverse effect of other agents primarily affecting the cardiovascular system, sequela

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

T46.995S, Adverse effect of other agents primarily affecting the cardiovascular system, sequela

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`T46.995S`, Adverse effect of other agents primarily affecting the cardiovascular system, sequela