Does Z36.3 require prior authorization?

No, Z36.3 does not require prior authorization (high confidence). Code is covered without prior authorization.

`Z36.3`, Encounter for antenatal screening for malformations

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Record of specimen type as fresh vaginal discharge.
Documented pH value (numeric) when pH testing performed.
Microscopy findings from both saline and KOH preparations, including presence/absence of motile T. vaginalis, clue cells, yeast, and white blood cells.
Result of whiff/amine test when performed.

Diagnostic testing to identify the etiology of signs and symptoms of vaginitis in members/enrollees aged ≥16 years.
Use of unspecified amplified DNA probe testing for evaluation of genitourinary conditions when performed as part of the diagnostic workup for vaginitis or other genitourinary infections.
KOH “whiff” (amine odor) test for symptomatic individuals ≥16 years for evaluation of vaginitis
Assay for sialidase activity for symptomatic individuals ≥16 years for evaluation of vaginitis
Direct and amplified DNA probe tests to detect Candida and Gardnerella vaginalis for symptomatic individuals ≥16 years for evaluation of vaginitis
pH testing of vaginal discharge to assist in evaluation of vaginal symptoms; an elevated pH (>4.5) is commonly associated with bacterial vaginosis (BV) or Trichomonas vaginalis.

AMBETTER-CP.MP.97, Testing for Select Genitourinary Conditions

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