Does Z16.21 require prior authorization?

No, Z16.21 does not require prior authorization (high confidence). Covered without prior authorization.

`Z16.21`, Resistance to vancomycin

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Avian influenza A virus (H5N1): documentation of symptoms consistent with Avian influenza A virus and history of travel to or contact with persons or birds from a country with documented H5N1 avian influenza infections within 10 days of symptom onset.
Cerebrospinal fluid (CSF) pathogen panel: Member has clinical findings consistent with a central nervous system (CNS) infection (e.g., meningitis, encephalitis); and viral etiology is suspected or the CSF culture is inconclusive for pathogen etiology (i.e., viral, bacterial, fungal).
Coronavirus COVID-19 respiratory panel (up to 5 respiratory pathogens): Member has signs and symptoms of COVID-19 and test will be used to guide therapy.
Gastrointestinal pathogen panel: documentation that member has community-acquired diarrhea of 7 days or more duration; or travel-related diarrhea; or diarrhea with signs or risk factors for severe disease (fever, bloody diarrhea, dysentery, dehydration, severe abdominal pain, hospitalization and/or immunocompromised state). For >11-target panels documentation that member is critically ill or immunocompromised. For >11-target panels R19.7 (diarrhea, unspecified) is required for claims.

Acanthamoeba in corneal ulceration
Actinomyces, for identification of actinomyces species in tissue specimens
Adenovirus, to diagnose adenovirus myocarditis, and to diagnose adenovirus infection in immunocompromised hosts, including transplant recipients
Anaplastic lymphoma kinase (ALK) testing as an alternative to FISH for selecting individuals for ALK inhibitor therapy
Avian influenza A virus, for diagnosis of avian influenza A (H5N1) in persons with both: Symptoms consistent with Avian influenza A virus (see background); and A history of travel to or contact with persons or birds from a country with documented H5N1 avian influenza infections within 10 days of symptom onset.
Babesiosis (Babesia spp.), diagnosis

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

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