Does T61.04XA require prior authorization?

No, T61.04XA does not require prior authorization (high confidence). Covered without prior authorization.

`T61.04XA`, Ciguatera fish poisoning, undetermined, initial encounter

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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.
Follow LCD L35434 for reasonable and necessary requirements and supporting medical documentation for oximetry services.
Report overnight oximetry using CPT code 94762 on claims.
Medical records must document the signs, symptoms, diagnosis, or clinical rationale that meet one of the covered indications (e.g., acute respiratory symptoms, chronic respiratory/cardiopulmonary/neuromuscular disease and the specific reason for oximetry).

Oximetry is medically necessary for patients exhibiting acute respiratory dysfunction signs or symptoms (tachypnea, dyspnea, cyanosis, respiratory distress, confusion, or hypoxia).
Oximetry is medically necessary for patients with chronic lung disease, severe cardiopulmonary disease, or neuromuscular disease affecting respiratory muscles when used for initial evaluation to determine the severity of respiratory impairment.
Oximetry is medically necessary for patients with chronic lung disease, severe cardiopulmonary disease, or neuromuscular respiratory muscle disease to evaluate an acute change in condition.
Oximetry is medically necessary to evaluate exercise tolerance in a patient with respiratory disease.
Oximetry is medically necessary to establish the medical necessity of an oxygen therapeutic regimen in patients with chronic respiratory, cardiopulmonary, or neuromuscular disease affecting respiration.
Oximetry is medically necessary for patients with sustained severe multiple trauma or who present with acute severe chest pain.

NOVITAS-JH-L35434, Oximetry Services

NOVITAS-JL-L35434, Oximetry Services

A57205, Billing and Coding: Oximetry Services

A56612, Billing and Coding: CT of the Head

Ask Backwork about documentation requirements, denial risks, or coverage in your state.