Does Z87.892 require prior authorization?

No, Z87.892 does not require prior authorization (high confidence). Covered without prior authorization.

`Z87.892`, Personal history of anaphylaxis

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Informed consent with realistic expectations documented in the medical record.
When applicable, documentation of prior surgeries (e.g., prior marrow stimulation techniques) and their timing, and rationale if ACI is being considered after prior treatments.
Past surgical history: documentation of prior cartilage procedures (e.g., microfracture, marrow-stimulation, osteochondral grafting) because prior procedures affect outcomes and may influence appropriateness (studies stratify and report prior surgeries).
For deep osteochondral lesions or procedures combining bone grafting, documentation of defect depth (>8–10 mm) and rationale for bone graft/combined technique (e.g., 'sandwich' technique).

Aetna considers autologous chondrocyte implants medically necessary for repairing cartilage defects of the knee in members who have symptoms of disabling knee pain related to a full thickness, focal chondral defect with all of the following:
Age 15 years or older with documented growth plate closure, or adults less than 55 years of age;
Body mass index (BMI) less than or equal to 35 (see Appendix);
Cooperative person for post-operative weight bearing restrictions and activity restrictions together with a potential for completion of post-operative rehabilitation;
Failure of conservative therapy (minimum of 2 months of physical therapy);
Focal articular cartilage defect down to but not through the subchondral bone on a load bearing surface of the femoral condyle (medial, lateral, trochlear) or the patella) (i.e., grade IV chondral defect);

AETNA-CPB-0247, Autologous Chondrocyte Implantation

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