Does Z11.2 require prior authorization?

No, Z11.2 does not require prior authorization (low confidence). No active coverage policies found for this code.

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`Z11.2`, Encounter for screening for other bacterial diseases

ICD-10-CM

Prior Authorization

No Prior Auth Required

No active coverage policies found for this code (low 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.
When billing CPT 87641 for screening purposes (statutorily non-covered), ICD-10-CM diagnosis codes may be reported but payment will still be denied.

Key Coverage Criteria

Direct DNA probe assays (e.g., Affirm VP/VP III) for detection of Trichomonas vaginalis, Candida species, and Gardnerella vaginalis for members WITH SYMPTOMS OF VAGINITIS
Measurement of sialidase activity in vaginal fluid (e.g., BVBlue test) for WOMEN WITH SYMPTOMS OF VAGINITIS
Testing of vaginal pH and testing for presence of amines (e.g., FemExam) for WOMEN WITH SYMPTOMS OF VAGINITIS
Nucleic acid amplification (PCR/NAAT) tests for diagnosis of bacterial vaginosis (examples: BD MAX Vaginal Panel, Aptima BV, NuSwab VG, OneSwab BV Panel PCR with Lactobacillus Profiling, SureSwab BV) in WOMEN WITH SYMPTOMS OF VAGINITIS
Nucleic acid amplification (PCR/NAAT) tests for diagnosis of Candida vaginitis (detection of Candida albicans, glabrata, krusei, parapsilosis, tropicalis) in WOMEN WITH SYMPTOMS OF VAGINITIS (examples: BD MAX vaginitis panel, GenPath GenPap, INFINITI Candida Vaginosis QUAD Assay, LabCorp NuSwab, MDL OneSwab, Quest SureSwab)
Screening for Trichomonas vaginalis with NAAT, direct probe, or antigen detection tests for WOMEN WITH RISK FACTORS (examples: new or multiple partners; history of sexually transmitted diseases; exchange of sex for payment; injection drug use)

6 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)

AMBETTER-CP.MP.97, Testing for Select Genitourinary Conditions

CIGNA-0398, Transvaginal Ultrasound, Non-Obstetrical

AETNA-CPB-0177, Helicobacter Pylori Infection Testing

AETNA-CPB-0643

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Z11.2, Encounter for screening for other bacterial diseases