Does Z65.8 require prior authorization?

No, Z65.8 does not require prior authorization (high confidence). Code is covered without prior authorization.

`Z65.8`, Other specified problems related to psychosocial circumstances

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

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.
Documentation that the member meets the transplanting institution's selection criteria; OR if no institution criteria exist, documentation that both required numeric criteria are met: calculated creatinine clearance (Cockcroft-Gault) < 20 ml/min OR directly measured GFR < 20 ml/min, AND documented ESRD with current dialysis or expectation of requiring dialysis within the next 12 months.

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.
Simultaneous pancreas-kidney (SPK) transplantation is medically necessary for members with diabetes and end-stage renal disease (ESRD) who meet the transplanting institution's selection criteria.
Aetna considers SPK and SPLK transplantation medically necessary for persons with certain relative contraindications if the attending physician determines and documents that the potential benefits of SPK or SPLK transplantation outweigh the risks (relative contraindications listed separately).
CPT/HCPCS/Coding context: Specific CPT codes (e.g., 48554 Transplantation of pancreatic allograft; 50360 Renal allotransplantation; donor nephrectomy codes 50300/50320/50547; and others listed) and HCPCS S2065 (Simultaneous pancreas kidney transplantation) are listed as covered if selection criteria are met.

NOVITAS-JH-L35101, Psychiatric Codes

NOVITAS-JL-L35101, Psychiatric Codes

A57130, Billing and Coding: Psychiatric Codes

AETNA-CPB-0587, Pancreas Kidney Transplantation

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