Does Z01.810 require prior authorization?

No, Z01.810 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

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`Z01.810`, Encounter for preprocedural cardiovascular examination

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

The patient's medical record must document medical necessity including relevant medical history, physical examination findings, and results of pertinent diagnostic tests or procedures supporting the clinical diagnosis and specific reason for the study.
All segments of the cardiovascular nuclear medicine service must have a formal interpretation and report documented in the medical record.
The referral/order must include the medical indication for the study and be retained in the patient's medical record.

Key Coverage Criteria

Cardiovascular nuclear medicine testing is reimbursable for risk assessment or re-evaluation in asymptomatic patients or patients with stable symptoms who have known atherosclerotic heart disease on catheterization or SPECT perfusion imaging, provided the patient has not undergone a revascularization procedure within the prior 2 years.
Blood pool scan to assess left ventricular ejection fraction prior to implantation of an implantable cardioverter-defibrillator (ICD) or biventricular pacemaker is covered when the medical record documents the intended plan for device insertion and the test result.
Simultaneous cardiac function studies using the first-pass technique performed with perfusion imaging (CPT 78451-78454) and reported with CPT 78472 and add-on 78496 are covered when the formal report documents that first-pass cardiac function studies were performed and the laboratory is equipped to perform them.
Transthoracic echocardiography (TTE) is covered when the patient's medical record documents medical necessity consistent with the LCD indications for TTE.
Contrast (contrast-enhanced) echocardiography is covered when conventional echocardiographic studies were inconclusive and contrast enhancement is needed to complete diagnostic evaluation.
Repeat echocardiographic studies are covered to monitor changes in cardiac structure or function when there is a change in clinical status or when disease progression is suspected.

20 Active Policies

CGS-J15-L33959, Cardiac Catheterization and Coronary Angiography

J15

CGS-J15-L33960, Cardiovascular Nuclear Medicine

J15

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J18-L34338, Transthoracic Echocardiography (TTE)

J18

CGS-J18-L33959, Cardiac Catheterization and Coronary Angiography

J18

CGS-J18-L33960, Cardiovascular Nuclear Medicine

J18

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

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

A57592, Billing and Coding: Non-Invasive Cerebrovascular Studies

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

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

WPS-J5-L35753, Non-Invasive Cerebrovascular Studies

NGS-J6-L33577, Transthoracic Echocardiography (TTE)

NGS-J6-L33560, Cardiovascular Nuclear Medicine

A56743, Billing and Coding: Cardiovascular Nuclear Medicine

A56781, Billing and Coding: Transthoracic Echocardiography (TTE)

WPS-J8-L35753, Non-Invasive Cerebrovascular Studies

WPS-J8-L35761, Non-Invasive Peripheral Arterial Vascular Studies

WPS-J8-L35751, Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies

FIRST_COAST-L33695, Non-invasive Extracranial Arterial Studies

`Z01.810`, Encounter for preprocedural cardiovascular examination

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

Z01.810, Encounter for preprocedural cardiovascular examination

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`Z01.810`, Encounter for preprocedural cardiovascular examination