Does T63.061A require prior authorization?

No, T63.061A does not require prior authorization (high confidence). Covered without prior authorization.

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`T63.061A`, Toxic effect of venom of other North and South American snake, accidental (unintentional), 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 patient's medical record must contain documentation that fully supports medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Each claim must be submitted with ICD-10-CM code(s) that reflect the patient's condition and indicate the reason(s) the service was performed; claims without ICD-10-CM codes will be returned.

Key Coverage Criteria

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.
CPT code 86003 (RAST type test) is covered when billed for diagnostic testing, subject to the stated annual frequency limit.
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.
Home-based ECG services (including additional payment above the base ECG amount for transportation) are covered when there is a documented medical need to perform the ECG in the patient's home, typically for homebound or bed-confined patients.

18 Active Policies

CGS-J15-L40325, Allergy Diagnostic Testing

J15

CGS-J15-L34063, RAST Type Tests

J15

CGS-J18-L40325, Allergy Diagnostic Testing

J18

CGS-J18-L34063, RAST Type Tests

J18

A57554, Billing and Coding: Immune Globulins

WPS-J5-L34771, Immune Globulins

NGS-J6-L40329, Allergy Diagnostic Testing

A56844, Billing and Coding: RAST Type Tests

NGS-J6-L33591, RAST Type Tests

WPS-J8-L34771, Immune Globulins

NOVITAS-JH-L35434, Oximetry Services

NGS-JK-L33591, RAST Type Tests

NGS-JK-L40329, Allergy Diagnostic Testing

NOVITAS-JL-L35434, Oximetry Services

A57205, Billing and Coding: Oximetry Services

A56612, Billing and Coding: CT of the Head

A57326, Billing and Coding: Electrocardiograms

A57043, Billing and Coding: RAST Type Tests

`T63.061A`, Toxic effect of venom of other North and South American snake, accidental (unintentional), initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

18 Active Policies

Related Codes

Have a follow-up question?

T63.061A, Toxic effect of venom of other North and South American snake, accidental (unintentional), initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

18 Active Policies

Related Codes

Have a follow-up question?

`T63.061A`, Toxic effect of venom of other North and South American snake, accidental (unintentional), initial encounter