Does Z20.810 require prior authorization?

No, Z20.810 does not require prior authorization (high confidence). Covered without prior authorization.

`Z20.810`, Contact with and (suspected) exposure to anthrax

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

For use of raxibacumab, obiltoxaximab (Anthim), or Anthrasil: documentation that therapy is for inhalational anthrax (e.g., ICD-10 A22.1 Pulmonary anthrax), and that appropriate antibacterial drugs are being administered in combination (for Anthim and Anthrasil per policy).
For obiltoxaximab prevention use: documentation that alternative therapies are not available or not appropriate (policy states Anthim is medically necessary for prevention when alternatives are not available or not appropriate).
For vaccination during pregnancy: documentation of pregnancy status and evidence of aerosol exposure if vaccine is given as post-exposure prophylaxis.
Documentation of adverse reaction history: prior anaphylactic reaction to AVA or components, or history of prior anthrax infection (contraindication) should be recorded.

Aetna considers anthrax immunization a medically necessary preventive service for indications recommended by the Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP).
ACIP recommends pre-exposure anthrax vaccination for: Decontamination personnel and persons who work directly with the organism in the laboratory.
ACIP recommends pre-exposure anthrax vaccination for: Military personnel deployed to areas with high-risk for exposure to the organism (as when it is used as a biological warfare weapon).
ACIP recommends pre-exposure anthrax vaccination for: Persons who handle potentially infected animal products in high-incidence areas. (Incidence is low in the United States, but veterinarians who travel to work in other countries where incidence is higher should consider being vaccinated.)
ACIP recommends pre-exposure anthrax vaccination for: Persons who work with imported animal hides or furs in areas where standards are insufficient to prevent exposure to anthrax spores.
ACIP recommends pre-exposure anthrax vaccination for: Environmental investigators and remediation workers who, as part of their occupation, might repeatedly enter areas contaminated with B. anthracis spores.

AETNA-CPB-0483, Anthrax

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