Does Z83.710 require prior authorization?

No, Z83.710 does not require prior authorization (high confidence). Covered without prior authorization.

`Z83.710`, Family history of adenomatous and serrated polyps

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

When performed for surveillance of colonic neoplasia, report the appropriate CPT/HCPCS procedure code and the appropriate primary ICD-10-CM code plus one of the following secondary diagnosis codes: Z85.038, Z85.048, Z86.0100, Z86.0101, Z86.0102, or Z86.0109.
For high-risk post-surgical follow-up at 1 year (with continued 24-month screening eligibility), report HCPCS code G0105 as the appropriate screening/high-risk colonoscopy code.
All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service).

Colonoscopy/sigmoidoscopy/proctosigmoidoscopy is covered for surveillance of colonic neoplasia in patients with a history of colorectal cancer or colonic polyps.
A follow-up procedure is covered 1 year after surgery for treatment of colorectal cancer when the patient is identified as high-risk for colon cancer and is eligible for continued screenings.
Esophagogastroduodenoscopy (EGD) is covered when it meets the reasonable and necessary requirements specified in Local Coverage Determination L33583.
Preventive care services designated by the Affordable Care Act (ACA) and ACA-designated resources (USPSTF grade A or B recommendations; ACIP recommendations adopted by CDC Director; HRSA-supported comprehensive guidelines such as Bright Futures, Uniform Panel of Secretary's Advisory Committee on Heritable Disorders in Newborns and Children, HRSA Women's Preventive Services Guidelines).
Wellness examinations (preventive medicine comprehensive E/M services) for well-baby, well-child, well-adult and well-woman visits (CPT codes 99381-99387, 99391-99397, 99461; HCPCS G0402, G0438, G0439, S0610, S0612, S0613).
Age-specific well visit frequencies: ages 0 to 5 per AAP Bright Futures; ages 5 and above annual wellness exam; additional visits for women's contraception management.

FIRST_COAST-L33583, Diagnostic and Therapeutic Esophagogastroduodenoscopy

A57063, Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy

ANTHEM-CG-MED-70, Wireless Capsule Endoscopy for Gastrointestinal Imaging and the Patency Capsule

CIGNA-A004, Preventive Care Services

A56632, Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy

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