Does Z01.812 require prior authorization?

No, Z01.812 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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`Z01.812`, Encounter for preprocedural laboratory 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

A claim submitted without a valid ICD-10-CM diagnosis code will be returned as an incomplete claim under Section 1833(e) of the Social Security Act; diagnosis must best describe the patient's condition for which the service was performed.
For services requiring a referring/ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.
For diagnostic (non-screening) use of the test, report the test result if known; if result is not available, report the symptoms prompting the test.

Key Coverage Criteria

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.
A second professional component (PC) interpretation may be paid when a second physician’s substantially greater expertise is necessary and reasonable to clarify a questionable or confusing ECG finding and contributes substantially to diagnosis or treatment.
Neuropsychological testing (NPT) when provided to aid in the assessment of cognitive impairment due to medical or psychiatric conditions, when all of the following criteria are met: The number of hours or units requested for testing does not exceed the reasonable time necessary to address the clinical questions with the identified measures; and The testing techniques are validated for the proposed diagnostic question or treatment plan; and The testing techniques do not represent redundant measur [...]

6 Active Policies

A52379, Billing and Coding: CPT Code 87641 (Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, methicillin resistant, amplified probe technique)

ANTHEM-CG-MED-61, Preoperative Testing for Low Risk Invasive Procedures and Surgeries

CIGNA-0398, Transvaginal Ultrasound, Non-Obstetrical

CIGNA-0510, Transthoracic Echocardiography in Adults

AETNA-CPB-0158, Neuropsychological and Psychological Testing

A57326, Billing and Coding: Electrocardiograms

`Z01.812`, Encounter for preprocedural laboratory examination

Prior Authorization

Documentation Required

Key Coverage Criteria

6 Active Policies

Related Codes

Have a follow-up question?

Z01.812, Encounter for preprocedural laboratory examination

Prior Authorization

Documentation Required

Key Coverage Criteria

6 Active Policies

Related Codes

Have a follow-up question?

`Z01.812`, Encounter for preprocedural laboratory examination