Does Z02.6 require prior authorization?

No, Z02.6 does not require prior authorization (high confidence). No active policy covers this code.

`Z02.6`, Encounter for examination for insurance purposes

ICD-10-CM

No Prior Auth Required

No active policy covers this code (high confidence)

Documentation of clinical concern for symptomatic COVID-19 infection (e.g., symptoms consistent with COVID-19) when ordering molecular or antigen testing.
Documentation of known or suspected exposure to SARS-CoV-2 when that is part of the indication for testing.
Order must be placed and the test administered by a licensed or authorized healthcare provider (documentation of ordering provider and administration).
For antibody (serology) testing: documentation of prior molecular or antigen test results that were non-diagnostic, and documentation that the antibody test result will be used to aid in diagnosis of a condition related to COVID-19 (e.g., clinical notes supporting suspicion of MIS or post-acute sequelae).

Molecular or antigen in vitro diagnostic test for SARS-CoV-2 (COVID-19) infection when ALL of the following criteria are met: clinical concern for a symptomatic COVID-19 infection; individual with known or suspected exposure; ordered and administered by a licensed or authorized healthcare provider.
Antibody (serology) test for SARS-CoV-2 antibodies when: results of a molecular or antigen test is non-diagnostic for COVID-19 AND the results of the antibody test will be used to aid in the diagnosis of a condition related to COVID-19 infection (e.g., Multisystem Inflammatory Syndrome [MIS], post-acute sequelae).
Molecular/antigen tests (CPT/HCPCS listed in policy) billed with any diagnosis codes other than the specified non-covered screening/administrative codes are considered medically necessary when the above policy clinical criteria are met (policy notes 'All other codes').
Antibody (serology) testing (CPT codes listed under Antibody Testing) is considered medically necessary for diagnoses M35.81 (Multisystem inflammatory syndrome) and U09.9 (Post COVID-19 condition, unspecified) when applicable clinical criteria are met.

CIGNA-0557, COVID-19: In Vitro Diagnostic Testing

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