Does T82.898A require prior authorization?

No, T82.898A does not require prior authorization (high confidence). Covered without prior authorization.

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`T82.898A`, Other specified complication of vascular prosthetic devices, implants and grafts, initial encounter

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Medical documentation supporting reasonable and necessary determination for additional sessions must be included (examples: recent hospital records, office visit notes, dialysis progress notes, MCP visits) when billing 90999 KX.
Follow the WPS GHA LCD L37537 for full documentation requirements and utilization guidelines for frequency of hemodialysis.
For monthly claims submitted with Bill Type 72X and Revenue Codes 0821 and 0881, use one of the permitted line-item billing approaches consistent with the patient's plan of care and supporting documentation.

Billing and coding guidance for non-coronary vascular stents is dependent on the coverage indications, limitations, and medical necessity specified in the related Local Coverage Determination (LCD); consult the related LCD for the specific coverage and coding requirements.

Key Coverage Criteria

Report each hemodialysis session for ESRD patients on a separate line for claims with dates of service on or after April 1, 2007.
When hemodialysis prescription is 3 sessions per week and each session is furnished, bill each session as CPT 90999 with no modifier for routine conventional dialysis.
For dialysis sessions beyond 3 sessions per week that are reasonable and necessary and supported by medical documentation, bill each additional session as CPT 90999 with modifier KX to be considered for additional payment.
Non‑invasive abdominal/visceral vascular studies are covered when the test results will be used to directly inform or change the patient's clinical management.
A preoperative non‑invasive abdominal/visceral vascular study is covered as reasonable and necessary for patients undergoing bypass surgery (one preoperative scan considered reasonable).
Medically necessary follow‑up non‑invasive abdominal/visceral vascular studies after angioplasty are covered as indicated by the vascular distribution treated.

20 Active Policies

CGS-J15-L37575, Frequency of Hemodialysis

J15

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J15-L34062, Dialysis Access Maintenance

J15

CGS-J18-L34062, Dialysis Access Maintenance

J18

CGS-J18-L34045, Non-Invasive Vascular Studies

J18

CGS-J18-L37575, Frequency of Hemodialysis

J18

WPS-J5-L35755, Non-Invasive Abdominal / Visceral Vascular Studies

A57593, Billing and Coding: Non-Invasive Peripheral Arterial Vascular Studies

A57594, Billing and Coding: Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies

WPS-J5-L37537, Frequency of Hemodialysis

A57590, Billing and Coding: Non-Coronary Vascular Stents

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

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

WPS-J5-L35998, Non-Coronary Vascular Stents

A55703, Billing and Coding: Frequency of Hemodialysis

A57591, Billing and Coding: Non-Invasive Abdominal / Visceral Vascular Studies

NGS-J6-L37475, Frequency of Hemodialysis

NGS-J6-L35074, Heavy Metal Testing

NGS-J6-L33633, Magnetic Resonance Angiography (MRA)

NGS-J6-L33627, Non-Invasive Vascular Studies

`T82.898A`, Other specified complication of vascular prosthetic devices, implants and grafts, initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

T82.898A, Other specified complication of vascular prosthetic devices, implants and grafts, initial encounter

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`T82.898A`, Other specified complication of vascular prosthetic devices, implants and grafts, initial encounter