Does Z30.431 require prior authorization?

No, Z30.431 does not require prior authorization (high confidence). Covered without prior authorization.

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`Z30.431`, Encounter for routine checking of intrauterine contraceptive device

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

For embryo transfer guidance: documentation that US guidance was used during embryo transfer and catheter type if relevant (policy notes trials that compared US-guided transfer with clinical touch and catheter type can affect outcomes).
For cervical length screening: gestational age at measurement; measured cervical length and documentation of follow-up TV-US if cervical length is less than 25 mm (policy: "Women with cervical length less than 25 mm at 14 to 28 weeks should undergo a subsequent transvaginal ultrasound to confirm this finding").
For monitoring hereditary risk of ovarian cancer: documentation of high-risk status (policy example: "Transvaginal ultrasound may be medically necessary for monitoring women with Lynch II syndrome (BRCA2 mutation) for ovarian cancer").

For vasa previa diagnosis: documentation of transvaginal color Doppler findings showing membranous fetal vessels crossing or in close proximity to the internal cervical os (proximity definition and use of color Doppler are discussed in the policy).

For suspected ectopic pregnancy: documentation of serial hCG testing and the ultrasound findings; TV-US should be performed at presentation and repeated as indicated (policy cites serial hCG + TVUS approach).

For IUD evaluation: documentation that the IUD string is not visible or there is clinical suspicion that the IUD is malpositioned when verifying IUD position with TV-US.

Key Coverage Criteria

Evaluation of abnormal uterine bleeding;
Evaluation of congenital uterine anomalies;
Evaluation of infertility;
Transvaginal sonography with color Doppler for prenatal diagnosis of vasa previa (identification of membranous fetal vessels passing across or near the internal cervical os).
Transvaginal ultrasound as the primary imaging modality for suspected ectopic pregnancy (TVUS is the imaging test of choice to determine pregnancy location and should be performed at presentation and repeated as indicated).
Assessment of a pelvic mass (e.g., adenomyosis, cancer, cyst, and fibroid);

1 Active Policy

AETNA-CPB-0530, Transvaginal Ultrasonography

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Z30.431, Encounter for routine checking of intrauterine contraceptive device