Does Z13.228 require prior authorization?

No, Z13.228 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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`Z13.228`, Encounter for screening for other metabolic disorders

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

For any iontophoretic dermatologic or ophthalmologic application: documentation of agent(s) used, concentrations, device/model, current and duration parameters, and monitoring for local adverse effects (erythema, burns, corneal complications, etc.).
No documentation requirements are stated in this document chunk (bibliography).
For primary focal hyperhidrosis: documentation that the member is unresponsive to or unable to tolerate oral pharmacotherapy for excessive sweating (examples given: anti-cholinergics, beta-blockers, benzodiazepines).

For primary focal hyperhidrosis: documentation that significant disruption of professional and/or social life has occurred because of excessive sweating.

For primary focal hyperhidrosis: documentation that topical aluminum chloride or other extra-strength antiperspirants are ineffective or cause a severe rash.

For delivery of local anesthetic before emergent skin puncture/dermatologic procedures: documentation of emergent nature of procedure and rationale for iontophoretic local anesthesia (i.e., need for more rapid dermal anesthesia than topical agents).

Key Coverage Criteria

(Inferred from references) Iontophoresis for treatment of rheumatoid arthritic knees
(Inferred from references) Transepithelial iontophoresis corneal collagen cross-linking for progressive keratoconus
(Inferred from references) Whole-finger iontophoresis to increase blood flow in systemic sclerosis
(Inferred from references) Transdermal iontophoretic drug delivery platforms/technologies (general)
(Inferred from references) Conservative treatments, including iontophoresis, for patellar tendinopathy
(Inferred from references) Alternatives to oral opioids for cancer/postoperative pain including fentanyl iontophoretic transdermal system (ITS)

2 Active Policies

CIGNA-0398, Transvaginal Ultrasound, Non-Obstetrical

AETNA-CPB-0229, Iontophoresis

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Z13.228, Encounter for screening for other metabolic disorders