Does Z79.899 require prior authorization?

No, Z79.899 does not require prior authorization (high confidence). Covered without prior authorization.

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`Z79.899`, Other long term (current) drug therapy

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Medical records must document the clinical findings (visual field results, optic nerve/nerve fiber layer status, anterior chamber findings) that justify use of SCODI for glaucoma or retinal disease.
If SCODI is performed in addition to any of the listed procedures (92250, 92225/92226, 76512) on the same eye same day, the reason must be clearly stated in the medical record.
If SCODI and visual field tests are performed on the same day or within short intervals, the medically necessary rationale must be present in the medical record.
Providers/suppliers must notify the beneficiary in writing prior to rendering the service if they are aware the test may not be covered by Medicare; limitation of liability and refund requirements apply when denials are likely.
For Part A MAC claims and facilities outside the contractor's primary jurisdiction with nominated CGS Administrators, bill type and billing instructions apply; for FQHC services on or after April 1, 2010, bill type 77X should be used.
Patient allergy history must document absence of iodine allergy prior to administration of ICG.

Key Coverage Criteria

SCODI is medically reasonable and necessary for evaluation and monitoring of glaucoma when clinical data (optic nerve, retinal nerve fiber layer, anterior chamber, and visual field) are being used to diagnose or follow glaucoma.
SCODI may be used to follow glaucoma suspects or patients with mild glaucomatous damage who have visual field findings such as no detectable defect, mild generalized reduction in retinal sensitivity, mild constriction of isopters, nasal step peripheral to 20 degrees, or small relative Bjerrum area defects peripheral to 9 degrees.
SCODI may be used in glaucoma suspects or mild damage when optic nerve findings include symmetric or vertically elongated cup enlargement, intact neural rim with rim:disc ratio >0.2, focal notching, absence of definite pathologic cupping, or previously observed disc hemorrhage.
SCODI may be appropriate in patients with moderate glaucomatous damage to monitor progression, especially when alternating SCODI and visual field testing over time increases sensitivity to detect change.
Use SCODI to evaluate suspected progression when the clinical exam suggests glaucoma progression but visual fields do not show new deficits, or vice versa, provided the clinician documents the medical necessity.
SCODI is medically reasonable and necessary for evaluation and management of retinal disorders, particularly macular abnormalities, and for assessing response to therapy and need for ongoing or cessation of therapy.

20 Active Policies

CGS-J15-L34399, Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)

J15

CGS-J15-L38992, Electroretinography (ERG)

J15

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J15-L36029, Urine Drug Testing

J15

CGS-J15-L34394, Visual Fields Testing

J15

CGS-J15-L34061, Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

J15

CGS-J15-L34175, Ophthalmic Angiography (Fluorescein and Indocyanine Green)

J15

CGS-J18-L34394, Visual Fields Testing

J18

CGS-J18-L34061, Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

J18

CGS-J18-L34175, Ophthalmic Angiography (Fluorescein and Indocyanine Green)

J18

CGS-J18-L36029, Urine Drug Testing

J18

CGS-J18-L34338, Transthoracic Echocardiography (TTE)

J18

CGS-J18-L38992, Electroretinography (ERG)

J18

CGS-J18-L34399, Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)

J18

WPS-J5-L34636, Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring)

WPS-J5-L34645, Urine Drug Testing

WPS-J5-L34648, Bisphosphonate Drug Therapy

WPS-J5-L34615, Visual Fields

WPS-J5-L34633, Erythropoiesis Stimulating Agents (ESAs)

WPS-J5-L34658, Vitamin D Assay Testing

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Z79.899, Other long term (current) drug therapy

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Medical records must document the clinical findings (visual field results, optic nerve/nerve fiber layer status, anterior chamber findings) that justify use of SCODI for glaucoma or retinal disease.
If SCODI is performed in addition to any of the listed procedures (92250, 92225/92226, 76512) on the same eye same day, the reason must be clearly stated in the medical record.
If SCODI and visual field tests are performed on the same day or within short intervals, the medically necessary rationale must be present in the medical record.
Providers/suppliers must notify the beneficiary in writing prior to rendering the service if they are aware the test may not be covered by Medicare; limitation of liability and refund requirements apply when denials are likely.
For Part A MAC claims and facilities outside the contractor's primary jurisdiction with nominated CGS Administrators, bill type and billing instructions apply; for FQHC services on or after April 1, 2010, bill type 77X should be used.
Patient allergy history must document absence of iodine allergy prior to administration of ICG.

Key Coverage Criteria

SCODI is medically reasonable and necessary for evaluation and monitoring of glaucoma when clinical data (optic nerve, retinal nerve fiber layer, anterior chamber, and visual field) are being used to diagnose or follow glaucoma.
SCODI may be used to follow glaucoma suspects or patients with mild glaucomatous damage who have visual field findings such as no detectable defect, mild generalized reduction in retinal sensitivity, mild constriction of isopters, nasal step peripheral to 20 degrees, or small relative Bjerrum area defects peripheral to 9 degrees.
SCODI may be used in glaucoma suspects or mild damage when optic nerve findings include symmetric or vertically elongated cup enlargement, intact neural rim with rim:disc ratio >0.2, focal notching, absence of definite pathologic cupping, or previously observed disc hemorrhage.
SCODI may be appropriate in patients with moderate glaucomatous damage to monitor progression, especially when alternating SCODI and visual field testing over time increases sensitivity to detect change.
Use SCODI to evaluate suspected progression when the clinical exam suggests glaucoma progression but visual fields do not show new deficits, or vice versa, provided the clinician documents the medical necessity.
SCODI is medically reasonable and necessary for evaluation and management of retinal disorders, particularly macular abnormalities, and for assessing response to therapy and need for ongoing or cessation of therapy.

20 Active Policies

CGS-J15-L34399, Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)

J15

CGS-J15-L38992, Electroretinography (ERG)

J15

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J15-L36029, Urine Drug Testing

J15

CGS-J15-L34394, Visual Fields Testing

J15

CGS-J15-L34061, Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

J15

CGS-J15-L34175, Ophthalmic Angiography (Fluorescein and Indocyanine Green)

J15

CGS-J18-L34394, Visual Fields Testing

J18

CGS-J18-L34061, Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

J18

CGS-J18-L34175, Ophthalmic Angiography (Fluorescein and Indocyanine Green)

J18

CGS-J18-L36029, Urine Drug Testing

J18

CGS-J18-L34338, Transthoracic Echocardiography (TTE)

J18

CGS-J18-L38992, Electroretinography (ERG)

J18

CGS-J18-L34399, Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)

J18

WPS-J5-L34636, Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring)

WPS-J5-L34645, Urine Drug Testing

WPS-J5-L34648, Bisphosphonate Drug Therapy

WPS-J5-L34615, Visual Fields

WPS-J5-L34633, Erythropoiesis Stimulating Agents (ESAs)

WPS-J5-L34658, Vitamin D Assay Testing

Have a follow-up question?

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

Ask Backwork about Z79.899 Sign up free

`Z79.899`, Other long term (current) drug therapy

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`Z79.899`, Other long term (current) drug therapy

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

Z79.899, Other long term (current) drug therapy

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

Z79.899, Other long term (current) drug therapy

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`Z79.899`, Other long term (current) drug therapy

`Z79.899`, Other long term (current) drug therapy