Does T63.434A require prior authorization?

No, T63.434A does not require prior authorization (high confidence). Covered without prior authorization.

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`T63.434A`, Toxic effect of venom of caterpillars, undetermined, initial encounter

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.

Prior to testing there must be evidence that a history was obtained indicating possible allergy and that attempts were made to narrow the area of investigation so that the minimal necessary skin tests were selected.

The record must indicate which allergy test(s) were used, the interpretation(s), and measurement (in mm) of wheal and erythema responses or a standardized grading system for in vivo testing, as applicable.

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.

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.
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).

16 Active Policies

CGS-J15-L34063, RAST Type Tests

J15

CGS-J18-L34063, RAST Type Tests

J18

NGS-J6-L33591, RAST Type Tests

A56844, Billing and Coding: RAST Type Tests

A57531, Billing and Coding: Allergy Testing

FIRST_COAST-L33261, Allergy Testing

NOVITAS-JH-L35434, Oximetry Services

NOVITAS-JH-L36241, Allergy Testing

NGS-JK-L33591, RAST Type Tests

NOVITAS-JL-L36241, Allergy Testing

A56558, Billing and Coding: Allergy 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

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T63.434A, Toxic effect of venom of caterpillars, undetermined, initial encounter