Does Z83.719 require prior authorization?

No, Z83.719 does not require prior authorization (high confidence). Covered without prior authorization.

`Z83.719`, Family history of colon polyps, unspecified

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 ICD-10, CPT and HCPCS codes billed for a preventive service should follow standard coding guidelines and be reported with diagnosis and procedure codes that identify the services as preventive and not for treatment of injury or illness.
Preventive services must be submitted with a designated wellness diagnosis code or maternity diagnosis code in the primary position where indicated (select the appropriate Designated Wellness Code from the pertinent Code Group).

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.
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.
Administration/interpretation of health risk assessment instruments (e.g., suicide risk assessment; sudden cardiac arrest/death risk assessment) (96160, 96161).

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

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