Does Z13.6 require prior authorization?

No, Z13.6 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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`Z13.6`, Encounter for screening for cardiovascular 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

The medical record must contain documentation fully supporting medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Each echocardiography service requires a formal written report with interpretation retained in the record and copies of image documentation (paper or electronic) available for review.
A complete study must include M-mode and/or 2D measurements of LV end-diastolic diameter, LV end-systolic diameter, LV wall thickness, left atrial diameter, aortic valve excursion, and a qualitative description of LV function, or valid substitutes such as LV volumes, ejection fraction, and mass.

Key Coverage Criteria

Transthoracic echocardiography (TTE) is covered when the patient's medical record documents medical necessity consistent with the LCD indications for TTE.
Contrast (contrast-enhanced) echocardiography is covered when conventional echocardiographic studies were inconclusive and contrast enhancement is needed to complete diagnostic evaluation.
Repeat echocardiographic studies are covered to monitor changes in cardiac structure or function when there is a change in clinical status or when disease progression is suspected.
ICD-10 codes listed as covered if selection criteria are met: F17.210 - F17.219 (Nicotine dependence, cigarettes), Z13.6 (Encounter for screening for cardiovascular disorders [abdominal aortic aneurysm (AAA)]), Z87.891 (Personal history of nicotine dependence).
Aetna considers one-time ultrasound screening for abdominal aortic aneurysms (AAA) medically necessary for men 65 years of age or older.
CPT 76706 (Ultrasound, abdominal aorta, real time with image documentation, screening study for abdominal aortic aneurysm (AAA)) is covered if selection criteria are met (i.e., the covered indication above).

20 Active Policies

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J15-L36139, MolDX: Biomarkers in Cardiovascular Risk Assessment

J15

CGS-J18-L34338, Transthoracic Echocardiography (TTE)

J18

CGS-J18-L36139, MolDX: Biomarkers in Cardiovascular Risk Assessment

J18

A57559, Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment

WPS-J5-L36523, MolDX: Biomarkers in Cardiovascular Risk Assessment

A56781, Billing and Coding: Transthoracic Echocardiography (TTE)

NGS-J6-L33577, Transthoracic Echocardiography (TTE)

WPS-J8-L36523, MolDX: Biomarkers in Cardiovascular Risk Assessment

NGS-JK-L33577, Transthoracic Echocardiography (TTE)

AETNA-CPB-0140, Genetic Testing

AETNA-CPB-0229, Iontophoresis

AETNA-CPB-0353, Transcranial Doppler Ultrasonography

AETNA-CPB-0458, Peripheral Vascular Rehabilitation Programs

AETNA-CPB-0520, Magnetic Resonance Imaging of the Cardiovascular System - Cardiac MRI

AETNA-CPB-0579, T-Wave Alternans

AETNA-CPB-0618, Brain Natriuretic Peptide Testing

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

AETNA-CPB-0692, Acoustic Heart Sound Recording and Computer Analysis

AETNA-CPB-0702, Abdominal Aortic Aneurysm Screening

`Z13.6`, Encounter for screening for cardiovascular disorders

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

Z13.6, Encounter for screening for cardiovascular disorders

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`Z13.6`, Encounter for screening for cardiovascular disorders