Does T82.898S require prior authorization?

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

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`T82.898S`, Other specified complication of vascular prosthetic devices, implants and grafts, sequela

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Billing must be based on the patient's Plan of Care (POC) or other available medical records; dialysis sessions listed in the POC that were not furnished must not be billed.
Additional sessions billed with the KX modifier must be supported by medical documentation demonstrating reasonableness and necessity, such as recent hospital records, office visit notes, dialysis progress notes, or MCP visits.
Monthly claims submitted with Bill Type 72X and Revenue Codes 0821 and 0881 must follow the per-line billing approaches described and supporting documentation may be requested during reviews.

Key Coverage Criteria

Each dialysis session performed for an ESRD patient must be reported on a separate line for dates of service on or after 2007-04-01.
When the hemodialysis prescription is three times per week and each session is furnished, bill each session as CPT 90999 with no modifier; these sessions will be paid as routine conventional dialysis.
Dialysis sessions furnished in addition to three per week that have medical documentation supporting reasonable and necessary need should be billed as CPT 90999 with the KX modifier for consideration of additional payment.
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.

20 Active Policies

CGS-J15-L37575, Frequency of Hemodialysis

J15

CGS-J15-L34062, Dialysis Access Maintenance

J15

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J18-L37575, Frequency of Hemodialysis

J18

CGS-J18-L34062, Dialysis Access Maintenance

J18

CGS-J18-L34045, Non-Invasive Vascular Studies

J18

WPS-J5-L37537, Frequency of Hemodialysis

A55703, Billing and Coding: Frequency of Hemodialysis

NGS-J6-L35074, Heavy Metal Testing

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

NGS-J6-L33627, Non-Invasive Vascular Studies

NGS-J6-L33563, Incision and Drainage (I & D) of Abscess of Skin, Subcutaneous and Accessory Structures

A56766, Billing and Coding: Incision and Drainage (I&D) of Abscess of Skin, Subcutaneous and Accessory Structures

NGS-J6-L37475, Frequency of Hemodialysis

A56758, Billing and Coding: Non-Invasive Vascular Studies

A55672, Billing and Coding: Frequency of Hemodialysis

A56767, Billing and Coding: Heavy Metal Testing

A56747, Billing and Coding: Magnetic Resonance Angiography (MRA)

WPS-J8-L37537, Frequency of Hemodialysis

FIRST_COAST-L40288, Non-invasive Arterial Duplex Ultrasound of the Upper and Lower Extremities

`T82.898S`, Other specified complication of vascular prosthetic devices, implants and grafts, sequela

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

T82.898S, Other specified complication of vascular prosthetic devices, implants and grafts, sequela

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`T82.898S`, Other specified complication of vascular prosthetic devices, implants and grafts, sequela