Does Z13.30 require prior authorization?

No, Z13.30 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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`Z13.30`, Encounter for screening examination for mental health and behavioral disorders, unspecified

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 MindX tests: "A qualified laboratory professional compiles the report that is communicated to the ordering provider detailing risk and medication suggestions."
"Requested by a psychiatrist as an aid to differentiate psychotic depression from schizophrenia."
Claims must be submitted in accordance with the relevant criteria outlined in the applicable Coverage Policy, including covered diagnosis and/or procedure code(s); services billed for conditions or diagnoses that are not covered under this Coverage Policy will be denied.

For evaluation/surveillance of women at increased risk for ovarian or endometrial cancer, documentation should support high-risk status (e.g., personal/family history consistent with hereditary cancer syndromes, BRCA mutation status, Lynch syndrome risk) as indicated by professional guidance cited in the policy.

Key Coverage Criteria

Dexamethasone suppression test (DST) — "medically necessary when it is requested by a psychiatrist as an aid to differentiate psychotic depression from schizophrenia."
Non-obstetrical transvaginal ultrasound is considered medically necessary for the evaluation of suspected pelvic pathology.
Non-obstetrical transvaginal ultrasound is considered medically necessary for screening or surveillance of a woman at increased risk for ovarian or endometrial cancer.
Evaluation of unexplained bleeding in the postmenopausal woman (TVUS can suggest presence of polyps, abnormal endometrial histology such as adenomatous hyperplasia, or cancer).
Evaluation of a pelvic mass to provide information about the location of a pelvic mass relative to the ovary and uterus and to better delineate internal architectural characteristics.
Evaluation of patients with acute pelvic pain (TVUS can help rule out ovarian primary source for acute pain when ovaries appear normal and no free intraperitoneal fluid is present).

2 Active Policies

CIGNA-0398, Transvaginal Ultrasound, Non-Obstetrical

AETNA-CPB-0306, Laboratory Tests for Depression and Other Psychiatric Disorders

`Z13.30`, Encounter for screening examination for mental health and behavioral disorders, unspecified

Prior Authorization

Documentation Required

Key Coverage Criteria

2 Active Policies

Related Codes

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Z13.30, Encounter for screening examination for mental health and behavioral disorders, unspecified

Prior Authorization

Documentation Required

Key Coverage Criteria

2 Active Policies

Related Codes

Have a follow-up question?

`Z13.30`, Encounter for screening examination for mental health and behavioral disorders, unspecified