Does Z85.020 require prior authorization?

No, Z85.020 does not require prior authorization (high confidence). Covered without prior authorization.

`Z85.020`, Personal history of malignant carcinoid tumor of stomach

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Use CPT codes 78472, 78473, 78481, 78483, 78494, or 78496 when billing cardiac blood pool imaging (MUGA, ventriculography).
When applicable, include the additional secondary code indicating personal history of malignant neoplasm (Z85 series) per Correct Coding Initiative (CCI) guidelines alongside the appropriate C-code or D-code family entry.
Refer to the policy's Covered ICD-10 Codes section to select the appropriate C-code, D-code, and Z85 family codes for billing cardiac blood pool imaging.
The submitted CPT/HCPCS code must accurately describe the service performed.

Cardiac blood pool imaging (MUGA, ventriculography) is covered when performed for patients receiving cardiotoxic chemotherapy.
Cardiac blood pool imaging is covered for evaluation of valvular disease or cardiomyopathies.
Prior to initiation of cardiotoxic chemotherapy, bill cardiac blood pool imaging with ICD-10 code Z01.89 plus the appropriate C-code or D-code family entry.
During or for interval assessment while receiving cardiotoxic chemotherapy, bill using the appropriate T45.1X5* encounter code (T45.1X5A, T45.1X5D, or T45.1X5S) to indicate ongoing exposure.
At completion of cardiotoxic chemotherapy, bill cardiac blood pool imaging with ICD-10 code Z08 and the appropriate C-code or D-code family entry.
Diagnostic colonoscopy is covered when the service meets the reasonable and necessary requirements specified in Local Coverage Determination L33671.

CGS-J15-L38822, MolDX: Minimal Residual Disease Testing for Cancer

J15

CGS-J18-L38822, MolDX: Minimal Residual Disease Testing for Cancer

J18

WPS-J5-L38835, MolDX: Minimal Residual Disease Testing for Cancer

WPS-J5-L39040, MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer

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