Does Z11.8 require prior authorization?

No, Z11.8 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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`Z11.8`, Encounter for screening for other infectious and parasitic 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

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

Chlamydia screening is recommended for the following groups: Women 25 years and older with any of the following risk factors for C. trachomatis infection: Having had C. trachomatis or other sexually transmitted diseases in the past;
Chlamydia screening is recommended for the following groups: Women 25 years and older with any of the following risk factors for C. trachomatis infection: New or multiple sexual partners;
Chlamydia trachomatis (C. trachomatis) screening a medically necessary preventive service according to the recommendations of the National Institute for Health and Clinical Excellence, United States Preventive Services Task Force (USPSTF) and the Centers for Disease Control and Prevention (CDC).
Chlamydia screening is recommended for the following groups: All pregnant women in the first trimester;
Chlamydia screening is recommended for the following groups: All sexually active women aged 24 years and younger;
ICD-10 codes covered if selection criteria are met: Z72.51 - Z72.53 (High-risk sexual behavior)

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-0433, Herpes Simplex Virus - Screening and Diagnosis

AETNA-CPB-0643, Diagnosis of Vaginitis

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

`Z11.8`, Encounter for screening for other infectious and parasitic diseases

Prior Authorization

Documentation Required

Key Coverage Criteria

6 Active Policies

Related Codes

Have a follow-up question?

Z11.8, Encounter for screening for other infectious and parasitic diseases

Prior Authorization

Documentation Required

Key Coverage Criteria

6 Active Policies

Related Codes

Have a follow-up question?

`Z11.8`, Encounter for screening for other infectious and parasitic diseases