Does Z34.93 require prior authorization?

No, Z34.93 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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`Z34.93`, Encounter for supervision of normal pregnancy, unspecified, third trimester

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

Claims must include the appropriate CPT® or PLA code; if no proprietary CPT/PLA code exists, bill with the appropriate CPT® code or CPT® 87999 if no other CPT describes the service.
Tests billed with CPT® 87999 or tests without a proprietary CPT/PLA code require submission of a DEX Z-code identifier and a MolDX Technical Assessment (TA).
Enter the appropriate DEX Z-code adjacent to the CPT® code in the specified claim fields: Part B — Loop 2400 or SV101-7 (837P) and Box 19 (paper); Part A — Line SV202-7 (837I) and Block 80 (UB04).

Key Coverage Criteria

Molecular syndromic infectious disease panels are covered when billed with the appropriate proprietary CPT® or PLA code and an accompanying ICD-10-CM diagnosis that documents medical necessity in the patient record.
FDA-cleared/approved molecular infectious disease tests performed consistent with their intended use are covered without a DEX Z-code when billed with an appropriate supporting ICD-10-CM code.
A panel is a single test (single unit of service UOS=1) and is covered as one service even if it reports multiple pathogens or targets.
Testing for additional organisms not included in a billed panel is covered when ordered in addition to the panel and supported by documentation in the medical record.
Expanded (>5 pathogen) respiratory (RP/PNP) and gastrointestinal (GI) panels are covered when either (a) performed at POS 19, 21, 22, or 23, or (b) ordered by an approved specialist per patient immune status and clinical indication (see documentation criteria).
Pre-transplant evaluation panels for immune-compromised beneficiaries are covered regardless of symptoms when clear pre-transplant documentation accompanies the claim.

20 Active Policies

CGS-J15-L39038, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

J15

CGS-J18-L39038, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

J18

A58761, Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

WPS-J5-L39044, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

WPS-J8-L39044, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

ANTHEM-CG-LAB-26, Outpatient Alpha-Fetoprotein Testing

ANTHEM-CG-RAD-26, Maternity Ultrasound in the Outpatient Setting

ANTHEM-CG-LAB-24, Outpatient Urine Culture

ANTHEM-RAD.00038, Use of 3-D, 4-D or 5-D Ultrasound in Maternity Care

AETNA-CPB-0047, Prenatal Care Provided by Primary Care Physicians

AETNA-CPB-0088, Antepartum Fetal Surveillance

AETNA-CPB-0205, Phototherapy and Photochemotherapy (PUVA) for Skin Conditions

AETNA-CPB-0329, Home Births

AETNA-CPB-0411, Bone and Tendon Graft Substitutes and Adjuncts

AETNA-CPB-0421, Breast Pumps

AETNA-CPB-0438, Obsolete and Unreliable Tests and Procedures

AETNA-CPB-0553, Lead Testing

AETNA-CPB-0643, Diagnosis of Vaginitis

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

AETNA-CPB-0657, Tubal Sterilization

`Z34.93`, Encounter for supervision of normal pregnancy, unspecified, third trimester

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

Z34.93, Encounter for supervision of normal pregnancy, unspecified, third trimester

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`Z34.93`, Encounter for supervision of normal pregnancy, unspecified, third trimester