Does Z51.0 require prior authorization?

No, Z51.0 does not require prior authorization (high confidence). Covered without prior authorization.

`Z51.0`, Encounter for antineoplastic radiation therapy

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

This billing/coding guideline complements LCD L33459 (Computerized Axial Tomography (CT), Thorax); follow the LCD for clinical coverage and any required documentation or prior authorization rules.
For home infusion/home therapy codes (S9351, S9370): documentation of emetic risk category (high, moderate) when required and clinical justification for home-based administration (S9370 limited to high or moderate risk).
For Z51.0 and Z51.11 - Z51.12 when used for total body radiation: documentation that oral antiemetic therapy has failed or is contraindicated.
For all HCPCS/CPT codes listed as 'covered if selection criteria are met': documentation that the patient meets the CPB selection criteria (specific selection criteria and required documentation elements are referenced but not included in this excerpt).

Prevention of acute nausea or vomiting associated with initial and repeat courses of moderately and highly emetogenic cancer chemotherapy, including high-dose cisplatin (palonosetron (Aloxi) or fosaprepitant dimeglumine (Emend)).
O21.0 - O21.9 — Excessive vomiting in pregnancy (when clinical signs of dehydration are present or nausea and vomiting have persisted more than 3 weeks and criteria A, B, and C are met)
B20 — Human immunodeficiency virus [HIV] disease
T45.1X5+ — Adverse effect of antineoplastic and immunosuppressive drugs (note: not covered for Anzemet per CPB)
Ondansetron or other 5-HT3 antagonists as pharmacologic options in refractory nausea and vomiting of pregnancy after first-line measures per ACOG; ondansetron may be tried in refractory cases as a last resort (ACOG-referenced).
Use of 5-HT3 receptor antagonists for management of postoperative nausea and vomiting and chemotherapy/radiotherapy-induced nausea and vomiting according to published guidelines (NCCN, ASCO, MASCC).

ANTHEM-MP-A050278, Last Review Date

CIGNA-CPG030, Low-Level Laser and High-Power Laser Therapy

CIGNA-0510, Transthoracic Echocardiography in Adults

AETNA-CPB-0231, Grenz Ray Therapy for Skin Disorders

AETNA-CPB-0240, Antineoplaston Therapy

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