Does Z71.7 require prior authorization?

No, Z71.7 does not require prior authorization (high confidence). Covered without prior authorization.

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`Z71.7`, Human immunodeficiency virus [HIV] counseling

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.
Claims must be submitted with an appropriate covered diagnosis code (ICD-10-CM) that corresponds to the indications listed in the Coding Information; reimbursement is not allowed for services billed with non-covered diagnoses.

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.
Nucleic acid pathogen testing for certain sexually transmitted infections is considered medically necessary for EITHER: (1) asymptomatic individual with any of the following: high-risk behavior (e.g., exposure to possible infected partner); high-risk condition (e.g., pregnancy, HIV infection); high-risk experience (e.g., assault); chlamydia screening in sexually active individual; gonorrhea screening in sexually active individual; human papillomavirus (HPV) cervical cancer screening; OR (2) symp [...]
Nucleic acid testing for Candida species when criteria in the policy are met (CPTs listed e.g., 87480, 87481). Covered Candida-related diagnoses include pulmonary candidiasis, vulvovaginal candidiasis, candidal meningitis, candidal endocarditis, candidal sepsis, candidal esophagitis, candidal enteritis and other candidiasis sites, and associated screening/high-risk Z-codes (examples: B37.1, B37.31, B37.5, Z11.4, Z71.7, Z72.51-Z72.53).
Nucleic acid testing for Chlamydia trachomatis when policy criteria are met (CPTs listed e.g., 87490,87491,87492). Covered diagnoses include chlamydial infections and related presentations (examples: A56.x, A64, cervicitis, urethritis, cystitis, pelvic inflammatory disease, sexual abuse encounter codes, pregnancy-related codes, and screening Z-codes).

5 Active Policies

NOVITAS-JH-L35101, Psychiatric Codes

NOVITAS-JL-L35101, Psychiatric Codes

A57130, Billing and Coding: Psychiatric Codes

CIGNA-0530, Nucleic Acid Pathogen Testing

ANTHEM-CG-LAB-03, Tropism Testing for HIV Management

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Z71.7, Human immunodeficiency virus [HIV] counseling