Does Z62.813 require prior authorization?

No, Z62.813 does not require prior authorization (high confidence). Covered without prior authorization.

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`Z62.813`, Personal history of forced labor or sexual exploitation in childhood

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Claims must meet the reasonable and necessary requirements described in the related LCD (L35101); providers must retain medical record documentation supporting medical necessity per the LCD.
When billing for services that are not covered, the claim must include the appropriate modifier to indicate non-coverage status.
When a second provider bills a diagnostic interview for a beneficiary they are seeing for the first time, documentation should support that it is the provider's first encounter with the beneficiary.

No documentation requirements are specified in this Clinical Policy Bulletin. (The document does not list required medical records, test results, or specific clinical documentation for coverage because the service is classified as experimental/investigational and not covered for the listed indications.)

Key Coverage Criteria

Diagnostic interview codes (e.g., CPT 90791/90792) are indicated for the initial evaluation of a beneficiary, and a second provider seeing the beneficiary for the first time may report diagnostic interview codes for that initial encounter.
CPT code 96105 is indicated for formal evaluation of aphasia using a standardized instrument (for example, the Boston Diagnostic Aphasia Examination).
HCPCS codes G0017 and G0018 are appropriate for services provided in non-facility places of service other than Office.
children and adolescents with mental illness
Mounted equine-assisted therapies (horse riding) as a component of EAT programs
Stroke (post-stroke hemiparesis; post-stroke patients in the 1st year post-stroke)

4 Active Policies

NOVITAS-JH-L35101, Psychiatric Codes

NOVITAS-JL-L35101, Psychiatric Codes

A57130, Billing and Coding: Psychiatric Codes

AETNA-CPB-0151, Hippotherapy

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Z62.813, Personal history of forced labor or sexual exploitation in childhood