Does Z09 require prior authorization?

No, Z09 does not require prior authorization (high confidence). Covered without prior authorization.

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`Z09`, Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Screening mammography does not require a physician referral and is not subject to the Medicare Part B deductible or coinsurance.
Diagnostic mammography requires a treating provider's referral specifying the diagnosis prompting the request, except when a screening mammogram is converted to diagnostic on the same day (a note in the radiologist's report fulfills the referral requirement).
Breast ultrasound requires an order from the treating provider (physician or qualified non-physician practitioner), except this order requirement does not apply to hospital-based radiologists for inpatient or outpatient breast ultrasound.

Key Coverage Criteria

Breast MRI is indicated for patients with positive axillary nodes and no known primary breast lesion to locate an occult primary.
Medicare covers annual screening mammography for all women age >=40 and one baseline screening mammography for women age 35-39, using bilateral views.
Breast MRI is indicated for suspected implant rupture when MRI is planned or otherwise appropriate.
Diagnostic mammography is indicated for patients with signs or symptoms suggestive of breast malignancy (e.g., palpable mass, spontaneous nipple discharge, skin changes, unilateral breast pain, unilateral axillary lymphadenopathy).
Diagnostic mammography is indicated for radiographic abnormalities detected on screening mammography.
Diagnostic mammography is indicated when metastatic disease of undetermined etiology is present and the breast is suspected as the primary source, or for axillary lymphadenopathy of undetermined etiology.

20 Active Policies

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J15-L33960, Cardiovascular Nuclear Medicine

J15

CGS-J15-L34394, Visual Fields Testing

J15

CGS-J15-L34005, Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy

J15

CGS-J15-L33950, Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography

J15

CGS-J15-L34175, Ophthalmic Angiography (Fluorescein and Indocyanine Green)

J15

CGS-J15-L33959, Cardiac Catheterization and Coronary Angiography

J15

CGS-J15-L34399, Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)

J15

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J15-L36460, Bone Mass Measurement

J15

CGS-J15-L34061, Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

J15

CGS-J18-L33959, Cardiac Catheterization and Coronary Angiography

J18

CGS-J18-L33950, Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography

J18

CGS-J18-L33960, Cardiovascular Nuclear Medicine

J18

CGS-J18-L34005, Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy

J18

CGS-J18-L34045, Non-Invasive Vascular Studies

J18

CGS-J18-L34061, Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

J18

CGS-J18-L34175, Ophthalmic Angiography (Fluorescein and Indocyanine Green)

J18

CGS-J18-L34338, Transthoracic Echocardiography (TTE)

J18

CGS-J18-L34394, Visual Fields Testing

J18

`Z09`, Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

Z09, Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`Z09`, Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm