Does Z01.818 require prior authorization?

No, Z01.818 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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`Z01.818`, Encounter for other preprocedural 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 medical record must contain documentation fully supporting medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Each echocardiography service requires a formal written report with interpretation retained in the record and copies of image documentation (paper or electronic) available for review.
A complete study must include M-mode and/or 2D measurements of LV end-diastolic diameter, LV end-systolic diameter, LV wall thickness, left atrial diameter, aortic valve excursion, and a qualitative description of LV function, or valid substitutes such as LV volumes, ejection fraction, and mass.

Key Coverage Criteria

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.
ESA therapy is indicated for anemia due to decreased erythropoietin production or relative erythropoietin resistance, e.g., anemia of chronic renal failure or end-stage renal disease (ESRD).
ESA therapy is indicated to maintain hematologic targets with typical goals of hematocrit 30.0-36.0% (hemoglobin 10.0-12.0 g/dL) and the medical record should document rationale for dose changes or values outside these ranges.
ESA therapy may be considered for other chronic conditions not specifically addressed by this policy when the patient demonstrates considerable transfusion dependence and anemia-related symptoms and documentation supports reasonable and necessary use.

20 Active Policies

CGS-J15-L34046, Speech-Language Pathology

J15

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J15-L33960, Cardiovascular Nuclear Medicine

J15

CGS-J18-L33960, Cardiovascular Nuclear Medicine

J18

CGS-J18-L34046, Speech-Language Pathology

J18

CGS-J18-L34338, Transthoracic Echocardiography (TTE)

J18

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

A56795, Billing and Coding: Erythropoiesis Stimulating Agents (ESAs)

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

WPS-J5-L35753, Non-Invasive Cerebrovascular Studies

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

WPS-J5-L34633, Erythropoiesis Stimulating Agents (ESAs)

A57592, Billing and Coding: Non-Invasive Cerebrovascular Studies

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

NGS-J6-L40334, Erythropoiesis Stimulating Agents

A56781, Billing and Coding: Transthoracic Echocardiography (TTE)

NGS-J6-L40333, Erythropoiesis Stimulating Agents

NGS-J6-L33580, Speech-Language Pathology

NGS-J6-L33577, Transthoracic Echocardiography (TTE)

NGS-J6-L33560, Cardiovascular Nuclear Medicine

`Z01.818`, Encounter for other preprocedural examination

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

Z01.818, Encounter for other preprocedural examination

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`Z01.818`, Encounter for other preprocedural examination