Does T50.905A require prior authorization?

No, T50.905A does not require prior authorization (high confidence). Covered without prior authorization.

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`T50.905A`, Adverse effect of unspecified drugs, medicaments and biological substances, initial encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

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.

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.
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 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.

20 Active Policies

CGS-J15-L37598, Cystatin C Measurement

J15

CGS-J15-L34063, RAST Type Tests

J15

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J18-L34063, RAST Type Tests

J18

CGS-J18-L34338, Transthoracic Echocardiography (TTE)

J18

CGS-J18-L37598, Cystatin C Measurement

J18

WPS-J5-L36402, Allergy Testing

A57473, Billing and Coding: Allergy Testing

A56844, Billing and Coding: RAST Type Tests

NGS-J6-L33577, Transthoracic Echocardiography (TTE)

NGS-J6-L33591, RAST Type Tests

A56781, Billing and Coding: Transthoracic Echocardiography (TTE)

WPS-J8-L36402, Allergy Testing

A57780, Billing and Coding: Psychological and Neuropsychological Tests

FIRST_COAST-L34520, Psychological and Neuropsychological Tests

NOVITAS-JH-L35006, Controlled Substance Monitoring and Drugs of Abuse Testing

NOVITAS-JH-L35049, Monitored Anesthesia Care

NOVITAS-JH-L35101, Psychiatric Codes

NGS-JK-L33577, Transthoracic Echocardiography (TTE)

NGS-JK-L33591, RAST Type Tests

`T50.905A`, Adverse effect of unspecified drugs, medicaments and biological substances, initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

T50.905A, Adverse effect of unspecified drugs, medicaments and biological substances, initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`T50.905A`, Adverse effect of unspecified drugs, medicaments and biological substances, initial encounter