Does T50.905S require prior authorization?

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

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`T50.905S`, Adverse effect of unspecified drugs, medicaments and biological substances, sequela

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

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.

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).
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.

20 Active Policies

CGS-J15-L37598, Cystatin C Measurement

J15

CGS-J18-L37598, Cystatin C Measurement

J18

A56781, Billing and Coding: Transthoracic Echocardiography (TTE)

A56844, Billing and Coding: RAST Type Tests

NGS-J6-L33577, Transthoracic Echocardiography (TTE)

NGS-J6-L33591, RAST Type Tests

A57780, Billing and Coding: Psychological and Neuropsychological Tests

FIRST_COAST-L34520, Psychological and Neuropsychological Tests

NOVITAS-JH-L35049, Monitored Anesthesia Care

NOVITAS-JH-L35101, Psychiatric Codes

NGS-JK-L33577, Transthoracic Echocardiography (TTE)

NGS-JK-L33591, RAST Type Tests

NOVITAS-JL-L35101, Psychiatric Codes

NOVITAS-JL-L35049, Monitored Anesthesia Care

A57130, Billing and Coding: Psychiatric Codes

A57361, Billing and Coding: Monitored Anesthesia Care

A56948, Billing and Coding: Lab: Cystatin C Measurement

A56988, Billing and Coding: Cystatin C Measurement

A57643, Billing and Coding: Lab: Cystatin C Measurement

A56625, Billing and Coding: Echocardiography

`T50.905S`, Adverse effect of unspecified drugs, medicaments and biological substances, sequela

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

T50.905S, Adverse effect of unspecified drugs, medicaments and biological substances, sequela

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`T50.905S`, Adverse effect of unspecified drugs, medicaments and biological substances, sequela