Does Z01.84 require prior authorization?

No, Z01.84 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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`Z01.84`, Encounter for antibody response 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

MenB — Dosing schedule varies by vaccine brand; for persons who remain at increased risk for N. meningitidis serogroup B disease, a single dose booster is considered medically necessary 1 year after primary series completion, then every 2 to 3 years thereafter.
MenB — Vaccination of adolescents and young adults aged 16 to 23 years with a 2-dose MenB series on the basis of shared clinical decision-making (preferred age 16–18 years). Booster doses are not recommended by ACIP unless the person becomes at increased risk.
Meningococcal vaccine for hematopoietic cell transplant (HCT) recipients — HCT recipients of all ages who received vaccines prior to HCT should be revaccinated routinely after HCT, including meningococcal vaccines.
Meningococcal vaccine for solid organ transplant recipients — vaccination recommended for transplant recipients (context: altered immunocompetence and transplant-related immunosuppression).
Pregnancy/lactation: pregnant and lactating women should receive MenACWY vaccine if indicated; MenB vaccination during pregnancy should be deferred unless woman is at increased risk and benefits outweigh potential risks.
Persons with altered immunocompetence (functional or anatomic asplenia, persistent complement deficiency, complement inhibitor use, HIV) are recommended to receive both MenACWY and MenB vaccines.

3 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)

CIGNA-0398, Transvaginal Ultrasound, Non-Obstetrical

AETNA-CPB-0356, Meningococcal Vaccines

`Z01.84`, Encounter for antibody response examination

Prior Authorization

Documentation Required

Key Coverage Criteria

3 Active Policies

Related Codes

Have a follow-up question?

Z01.84, Encounter for antibody response examination

Prior Authorization

Documentation Required

Key Coverage Criteria

3 Active Policies

Related Codes

Have a follow-up question?

`Z01.84`, Encounter for antibody response examination