Does Z01.82 require prior authorization?

No, Z01.82 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

Backwork Sign up free

`Z01.82`, Encounter for allergy testing

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 include the ordering provider's assessment related to the patient's complaint for that visit.
The medical record must include relevant medical history and results of pertinent tests and procedures.
Office visit records and operative reports must be signed and dated; all services ordered or rendered to Medicare beneficiaries must be signed.
When using the -GA modifier and ABN, Form CMS-R-131 must be signed by the beneficiary (or properly witnessed if the beneficiary refuses to sign) to indicate acceptance of payment responsibility.

Key Coverage Criteria

For services that require a referring or ordering physician, the claim must report the referring/ordering physician's name and NPI.
Claims must include a valid ICD-10-CM diagnosis code that best describes the patient's condition for which the service was performed; otherwise the claim will be returned as incomplete under SSA Section 1833(e).
For diagnostic tests, the claim should report the test result if known, otherwise report the symptoms that prompted the test.
If a service is likely to be non-covered, an Advance Beneficiary Notice (ABN) may be used and the appropriate modifier (GA, GX, GY, or GZ) should be appended to the claim as applicable.
CPT code 93355 is used to report transesophageal echocardiography (TEE) performed during transcatheter intracardiac therapies.
When contrast is used for a complete TEE procedure (probe placement, image acquisition, interpretation and report), bill CPT code 93312 (HCPCS C8925 for OPPS billing).

13 Active Policies

CGS-J15-L33960, Cardiovascular Nuclear Medicine

J15

CGS-J15-L34337, Transesophageal Echocardiography (TEE)

J15

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J18-L34337, Transesophageal Echocardiography (TEE)

J18

CGS-J18-L33960

Have a follow-up question?

Ask Backwork about documentation requirements, denial risks, or coverage in your state.

Ask Backwork about Z01.82 Sign up free

Z01.82, Encounter for allergy testing