Does Z12.9 require prior authorization?

No, Z12.9 does not require prior authorization (high confidence). Covered without prior authorization.

`Z12.9`, Encounter for screening for malignant neoplasm, site unspecified

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

No explicit documentation requirements are stated in this Clinical Policy Bulletin.
For persistent knee pain/swelling/instability not associated with injury: documentation of failure to respond to at least 3 weeks of conservative therapy (where conservative therapy consists of a combination of rest, ice, compression, elevation, non-steroidal anti-inflammatory drugs (NSAIDs), crutches, and range of motion (ROM) exercises)
For persistent knee pain/swelling/instability secondary to injury: documentation that patient did not respond to conservative therapy and that multi-view x-rays have ruled out a fracture or loose body in the knee and that the clinical picture remains uncertain
For persistent true locking of the knee: documentation describing the locking (true locking defined in policy as more than a momentary locking with the knee in a flexed position) indicating suspicion for torn meniscus or loose body

None specified. Aetna considers the analysis of volatile organic compounds experimental and investigational for the indications listed below (see Limitations).
ICD-10 code covered if selection criteria are met for MRI-lymphangiography: I89.0 (Lymphedema, not elsewhere classified)
MRI for the diagnosis of CLOVES syndrome
MRI for the diagnosis of osteomyelitis in the foot
Detection, staging, and post-treatment evaluation of tumor of the knee
Persistent knee pain/swelling and/or instability (giving way) when: Not associated with an injury and not responding to at least 3 weeks of conservative therapy

AETNA-CPB-0029, Thermography

AETNA-CPB-0171, Magnetic Resonance Imaging (MRI) of the Extremities

AETNA-CPB-0608, Salivary Tests

AETNA-CPB-0717, Analysis of Volatile Organic Compounds

Ask Backwork about documentation requirements, denial risks, or coverage in your state.