Does T82.7XXA require prior authorization?

No, T82.7XXA does not require prior authorization (high confidence). Covered without prior authorization.

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`T82.7XXA`, Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

For prior-MI and cardiomyopathy primary prevention indications, document LVEF value and measurement method (echocardiography, radionuclide imaging, cardiac MRI, or catheter angiography).
For indications B2–B5, document a formal shared decision‑making encounter using an evidence‑based decision tool between the patient and a physician or qualified non‑physician practitioner prior to initial ICD implantation.
Document clinical stability (eg, not in shock) at time of implantation and absence of significant irreversible brain damage or non‑cardiac disease with life expectancy <1 year.

Key Coverage Criteria

Personal history of sustained ventricular tachycardia (spontaneous or EP-induced) not associated with an acute myocardial infarction and not due to a transient or reversible cause is an indication for ICD implantation.
Personal history of cardiac arrest due to ventricular fibrillation not due to a transient or reversible cause is an indication for ICD implantation.
Patients with prior myocardial infarction and measured left ventricular ejection fraction (LVEF) ≤ 0.30 are indicated for ICD implantation provided they do not have NYHA class IV heart failure, have not had CABG/PCI in the past 3 months, have not had an MI within the past 40 days, and are not candidates for coronary revascularization.
Patients with severe ischemic dilated cardiomyopathy, no prior sustained VT or VF arrest, NYHA class II or III heart failure, and LVEF ≤ 35% are indicated for ICD implantation provided they have not had CABG/PCI within 3 months, have not had MI within 40 days, and are not candidates for coronary revascularization.
Patients with severe non-ischemic dilated cardiomyopathy, no prior sustained VT or VF arrest, NYHA class II or III heart failure, LVEF ≤ 35%, and who have been on optimal medical therapy for at least 3 months are indicated for ICD implantation provided they have not had CABG/PCI within 3 months, have not had MI within 40 days, and are not candidates for coronary revascularization.
Patients with documented familial or genetic disorders conferring high risk of life‑threatening tachyarrhythmias (eg, long QT syndrome, hypertrophic cardiomyopathy) are indicated for ICD implantation.

20 Active Policies

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J15-L34337, Transesophageal Echocardiography (TEE)

J15

CGS-J15-L39038, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

J15

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J15-L34062, Dialysis Access Maintenance

J15

CGS-J15-L34005, Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy

J15

CGS-J15-L34032, Debridement Services

J15

CGS-J15-L39521, Positron Emission Tomography (PET) Scan for Inflammation and Infection

J15

CGS-J18-L34005, Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy

J18

CGS-J18-L39521, Positron Emission Tomography (PET) Scan for Inflammation and Infection

J18

CGS-J18-L39038, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

J18

CGS-J18-L34337, Transesophageal Echocardiography (TEE)

J18

CGS-J18-L34062, Dialysis Access Maintenance

J18

CGS-J18-L34032, Debridement Services

J18

CGS-J18-L34045, Non-Invasive Vascular Studies

J18

CGS-J18-L34338, Transthoracic Echocardiography (TTE)

J18

WPS-J5-L39044, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

WPS-J5-L35751, Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies

WPS-J5-L35761, Non-Invasive Peripheral Arterial Vascular Studies

A56391, Billing and Coding: Implantable Automatic Defibrillators

`T82.7XXA`, Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

T82.7XXA, Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`T82.7XXA`, Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter