Does Z20.828 require prior authorization?

No, Z20.828 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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`Z20.828`, Contact with and (suspected) exposure to other viral communicable diseases

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

Billing and coding for immunizations must follow the coverage indications, limitations, and medical necessity criteria set forth in the associated Local Coverage Determination LCD L34596 (Immunizations).
All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
Every page of the medical record must be legible and include appropriate patient identification (e.g., complete name, dates of service).

Key Coverage Criteria

Respiratory pathogen panel testing is covered when performed in an outpatient, non-institutional Part B setting from a single biologic specimen on a single date of service and the order is not a reflex test.
Respiratory pathogen panel testing is covered when the medical record documents that the testing facility can deliver timely results and that the test results can reasonably be expected to change clinical management and improve patient health outcomes.
Respiratory pathogen panel testing is covered when performed as a single service from a single biologic specimen in the outpatient setting on a single date of service and is reasonable and necessary per LCD L38918.
The test is covered when performed in a Medicare Part B setting that is equipped to deliver timely results and when the results can reasonably be expected to lead to a change in clinical management that improves health outcomes.
Respiratory pathogen panel testing is covered when performed in an outpatient Medicare Part B setting using a single biologic specimen collected and tested on a single date of service, and the results are timely and can affect clinical management to improve patient health outcomes.
A panel is defined as all respiratory pathogens tested on that single specimen/date and is covered when ordered as a panel (not as a reflex test).

16 Active Policies

A56900, Billing and Coding: Immunizations

WPS-J5-L34596, Immunizations

WPS-J8-L34596, Immunizations

FIRST_COAST-L38918, Respiratory Pathogen Panel Testing

NOVITAS-JH-L38916, Respiratory Pathogen Panel Testing

NGS-L39027, Respiratory Pathogen Panel Testing

NOVITAS-JL-L38916, Respiratory Pathogen Panel Testing

A58577, Billing and Coding: Respiratory Pathogen Panel Testing

CIGNA-0557, COVID-19: In Vitro Diagnostic Testing

A58741, Billing and Coding: Respiratory Pathogen Panel Testing

AETNA-CPB-0199, Ultrasound for Pregnancy

AETNA-CPB-0327, Infertility

AETNA-CPB-0542, HIV Testing

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

AETNA-CPB-0715, Pharmacogenetic and Pharmacodynamic Testing

A58575, Billing and Coding: Respiratory Pathogen Panel Testing

`Z20.828`, Contact with and (suspected) exposure to other viral communicable diseases

Prior Authorization

Documentation Required

Key Coverage Criteria

16 Active Policies

Related Codes

Have a follow-up question?

Z20.828, Contact with and (suspected) exposure to other viral communicable diseases

Prior Authorization

Documentation Required

Key Coverage Criteria

16 Active Policies

Related Codes

Have a follow-up question?

`Z20.828`, Contact with and (suspected) exposure to other viral communicable diseases