Does Z87.81 require prior authorization?

No, Z87.81 does not require prior authorization (high confidence). Covered without prior authorization.

`Z87.81`, Personal history of (healed) traumatic fracture

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation of failure to respond to appropriate conservative therapies (examples provided: rest, ice application, and medications).
Medical record evidence supporting that selection criteria were met prior to billing code 0101T (i.e., clinical notes, prior treatment attempts, imaging reports specifying deposit size and location).
If claiming coverage under the CPB, supporting clinical documentation must link the ICD-10 diagnosis to the policy-covered indication (i.e., calcific tendinopathy of shoulder meeting the above criteria) and should avoid coding that the policy explicitly lists as not covered (e.g., subacromial impingement syndrome).
None specified in this document. The text summarizes clinical studies and systematic reviews but does not provide insurer coverage documentation requirements (no required clinical notes, imaging, prior conservative therapy documentation, or ICD-10/CPT code lists are given in this excerpt).

AETNA-CPB-0151, Hippotherapy

AETNA-CPB-0174, Pool Therapy, Aquatic Therapy or Hydrotherapy

AETNA-CPB-0198, Work Hardening Programs

AETNA-CPB-0649, Extracorporeal Shock-Wave Therapy for Musculoskeletal Indications and Soft Tissue Injuries

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