Does Z86.73 require prior authorization?

No, Z86.73 does not require prior authorization (high confidence). Covered without prior authorization.

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`Z86.73`, Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

The medical record must contain documentation fully supporting medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Each echocardiography service requires a formal written report with interpretation retained in the record and copies of image documentation (paper or electronic) available for review.
A complete study must include M-mode and/or 2D measurements of LV end-diastolic diameter, LV end-systolic diameter, LV wall thickness, left atrial diameter, aortic valve excursion, and a qualitative description of LV function, or valid substitutes such as LV volumes, ejection fraction, and mass.

Key Coverage Criteria

Transthoracic echocardiography (TTE) is covered when the patient's medical record documents medical necessity consistent with the LCD indications for TTE.
Contrast (contrast-enhanced) echocardiography is covered when conventional echocardiographic studies were inconclusive and contrast enhancement is needed to complete diagnostic evaluation.
Repeat echocardiographic studies are covered to monitor changes in cardiac structure or function when there is a change in clinical status or when disease progression is suspected.
Holter monitoring (CPT 93224-93227) is covered for up to 48 hours of continuous recording when progress notes document medical necessity.
Wearable external mobile cardiac telemetry (CPT 93228 professional, 93229 technical) is covered as one unit per course of treatment that includes up to 30 consecutive days of cardiac monitoring when the documented services (hook-up, transmission, analysis, daily reports, equipment and supplies, and physician review) are provided.
Long-term continuous recorders (CPT 93241-93248) that continuously record and store for greater than 48 hours up to 7 days, or greater than 7 days up to 15 days, are covered in the outpatient setting when documentation supports medical necessity.

20 Active Policies

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

CGS-J15-L40244, Temporary Nontherapeutic Ambulatory Cardiac Monitoring Devices

J15

CGS-J15-L40243, Temporary Nontherapeutic Ambulatory Cardiac Monitoring Devices

J15

CGS-J15-L36139, MolDX: Biomarkers in Cardiovascular Risk Assessment

J15

CGS-J18-L40243, Temporary Nontherapeutic Ambulatory Cardiac Monitoring Devices

J18

CGS-J18-L34338, Transthoracic Echocardiography (TTE)

J18

CGS-J18-L40244, Temporary Nontherapeutic Ambulatory Cardiac Monitoring Devices

J18

CGS-J18-L36139, MolDX: Biomarkers in Cardiovascular Risk Assessment

J18

CGS-J18-L34045, Non-Invasive Vascular Studies

J18

WPS-J5-L35753, Non-Invasive Cerebrovascular Studies

WPS-J5-L36523, MolDX: Biomarkers in Cardiovascular Risk Assessment

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

A57592, Billing and Coding: Non-Invasive Cerebrovascular Studies

A57476, Billing and Coding: Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring)

A57559, Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment

A56781, Billing and Coding: Transthoracic Echocardiography (TTE)

NGS-J6-L39995, Pharmacogenomic Testing

NGS-J6-L33627, Non-Invasive Vascular Studies

NGS-J6-L33577, Transthoracic Echocardiography (TTE)

`Z86.73`, Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

Z86.73, Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`Z86.73`, Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits