Does Z12.73 require prior authorization?

No, Z12.73 does not require prior authorization (high confidence). Code is covered without prior authorization.

`Z12.73`, Encounter for screening for malignant neoplasm of ovary

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

For hepatic RBC SPECT for hemangioma evaluation: documentation that labeled RBC technique was used and correlation with other imaging (e.g., ultrasound/CT) to support non-invasive differentiation from malignant lesions.
For parathyroid SPECT/SPECT-CT: documentation of prior planar imaging and targeted use to localize ectopic parathyroid adenomas when surgical planning requires precise anatomic localization.
For SPECT/CT in bone metastasis characterization or indeterminate bone lesions: documentation of prior whole-body planar bone scan findings (indeterminate lesions) and correlation with clinical/imaging follow-up or histopathology when available.
For assessment of myocardial viability and use to guide revascularization decisions: documentation of clinical decision-making linking SPECT findings to proposed revascularization planning.

Localization of abscess for suspected or known localized infection or inflammatory process
Lymphoma, to distinguish tumor from necrosis
Diagnosing and assessing hemangiomas of the liver
Diagnosing pulmonary embolism by means of SPECT ventilation/perfusion scintigraphy (V/P SPECT)
Differentiation of necrotic tissue from tumor of the brain
Distinguishing Parkinson's disease from essential tremor (e.g., DaTSCAN [Ioflupane I-123 injection])

ANTHEM-CG-MED-84, Non-Obstetric Gynecologic Duplex Ultrasonography of the Abdomen and Pelvis in the Outpatient Setting

AETNA-CPB-0352, Tumor Markers

AETNA-CPB-0376, Single Photon Emission Computed Tomography (SPECT)

AETNA-CPB-0530, Transvaginal Ultrasonography

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