Does Z11.59 require prior authorization?

No, Z11.59 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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`Z11.59`, Encounter for screening for other viral diseases

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

Avian influenza A virus (H5N1): documentation of symptoms consistent with Avian influenza A virus and history of travel to or contact with persons or birds from a country with documented H5N1 avian influenza infections within 10 days of symptom onset.
Cerebrospinal fluid (CSF) pathogen panel: Member has clinical findings consistent with a central nervous system (CNS) infection (e.g., meningitis, encephalitis); and viral etiology is suspected or the CSF culture is inconclusive for pathogen etiology (i.e., viral, bacterial, fungal).

Gastrointestinal pathogen panel: documentation that member has community-acquired diarrhea of 7 days or more duration; or travel-related diarrhea; or diarrhea with signs or risk factors for severe disease (fever, bloody diarrhea, dysentery, dehydration, severe abdominal pain, hospitalization and/or immunocompromised state). For >11-target panels documentation that member is critically ill or immunocompromised. For >11-target panels R19.7 (diarrhea, unspecified) is required for claims.

Respiratory virus and/or bacteria panel: documentation of signs and symptoms of a respiratory infection; member is immunocompromised and/or high-risk for complications (e.g., receiving cancer treatment, organ transplant recipient); and documentation that test will be used to guide therapy.

Sepsis pathogen panel: documentation of signs and symptoms consistent with sepsis; molecular testing performed directly on a positive culture obtained from body fluid (e.g., blood); and documentation that test will be used to guide therapy.

Key Coverage Criteria

Acanthamoeba in corneal ulceration
Actinomyces, for identification of actinomyces species in tissue specimens
Adenovirus, to diagnose adenovirus myocarditis, and to diagnose adenovirus infection in immunocompromised hosts, including transplant recipients
Anaplastic lymphoma kinase (ALK) testing as an alternative to FISH for selecting individuals for ALK inhibitor therapy
Avian influenza A virus, for diagnosis of avian influenza A (H5N1) in persons with both: Symptoms consistent with Avian influenza A virus (see background); and A history of travel to or contact with persons or birds from a country with documented H5N1 avian influenza infections within 10 days of symptom onset.
Babesiosis (Babesia spp.), diagnosis

3 Active Policies

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

CIGNA-0398, Transvaginal Ultrasound, Non-Obstetrical

AETNA-CPB-0650, Polymerase Chain Reaction Testing: Selected Indications

`Z11.59`, Encounter for screening for other viral diseases

Prior Authorization

Documentation Required

Key Coverage Criteria

3 Active Policies

Related Codes

Have a follow-up question?

Z11.59, Encounter for screening for other viral diseases

Prior Authorization

Documentation Required

Key Coverage Criteria

3 Active Policies

Related Codes

Have a follow-up question?

`Z11.59`, Encounter for screening for other viral diseases