Does T78.00XA require prior authorization?

No, T78.00XA does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

Backwork Sign up free

`T78.00XA`, Anaphylactic reaction due to unspecified food, initial encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium 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.

16 Active Policies

CGS-J15-L34063, RAST Type Tests

J15

CGS-J18-L34063, RAST Type Tests

J18

A57473, Billing and Coding: Allergy Testing

WPS-J5-L36402, Allergy Testing

A56844, Billing and Coding: RAST Type Tests

NGS-J6-L33591, RAST Type Tests

WPS-J8-L36402, Allergy Testing

NOVITAS-JH-L35049, Monitored Anesthesia Care

NGS-JK-L33591, RAST Type Tests

A57361, Billing and Coding: Monitored Anesthesia Care

NOVITAS-JL-L35049, Monitored Anesthesia Care

A56612, Billing and Coding: CT of the Head

ANTHEM-LAB.00027, Selected Blood, Serum and Cellular Allergy and Toxicity Tests

ANTHEM-CG-LAB-29, Gamma Glutamyl Transferase Testing

A57043, Billing and Coding: RAST Type Tests

A57326, Billing and Coding: Electrocardiograms

`T78.00XA`, Anaphylactic reaction due to unspecified food, initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

16 Active Policies

Related Codes

Have a follow-up question?

T78.00XA, Anaphylactic reaction due to unspecified food, initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

16 Active Policies

Related Codes

Have a follow-up question?

`T78.00XA`, Anaphylactic reaction due to unspecified food, initial encounter