Does Z79.4 require prior authorization?

No, Z79.4 does not require prior authorization (high confidence). Covered without prior authorization.

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`Z79.4`, Long term (current) use of insulin

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

The patient's medical record must contain documentation that fully supports the medical necessity for the visual fields testing in accordance with the applicable LCD.
Documentation should include relevant medical history, a physical examination, and results of pertinent diagnostic tests or procedures supporting the need for visual fields testing.
The diagnosis code(s) reported on the claim must best describe the patient's condition for which the visual fields testing was performed.
Refer to NCCI and OPPS requirements prior to billing Medicare to ensure coding compliance and to determine any bundling or packaging edits.

Key Coverage Criteria

Vitamin D assay testing is covered when the medical record documents medical necessity for the test, including the clinical reason for testing and any planned repeat testing and frequency.
Note:Members must meet the disease specific criteria as well as the General Individual Selection criteria below for the transplantation to be considered medically necessary.
Simultaneous deceased-donor pancreas/kidney transplant (SPK) is consideredmedically necessaryfor individuals with insulin dependent diabetes mellitus (IDDM) who have end-stage renal disease.
Simultaneous deceased-donor pancreas and living-donor kidney transplant (SPLK) is consideredmedically necessaryfor individuals with insulin dependent diabetes mellitus who have end-stage renal disease.
Pancreas transplant alone (PTA) either deceased or living-donor segmental is consideredmedically necessaryfor individuals who have insulin dependent diabetes mellitus with severe disabling and documented life threatening hypoglycemic unawareness due to labile diabetes which persists despite optimal medical management.
Pancreas after kidney transplant (PAK) is consideredmedically necessaryfor individuals with insulin dependent diabetes mellitus.

20 Active Policies

CGS-J15-L40198, MolDX: Biomarker Testing for Risk Stratification in Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis

J15

CGS-J15-L40199, MolDX: Biomarker Testing in Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis

J15

CGS-J15-L34394, Visual Fields Testing

J15

CGS-J18-L34394, Visual Fields Testing

J18

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Z79.4, Long term (current) use of insulin