Does Z91.410 require prior authorization?

No, Z91.410 does not require prior authorization (high confidence). Covered without prior authorization.

`Z91.410`, Personal history of adult physical and sexual abuse

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Claims must meet the reasonable and necessary requirements described in the related LCD (L35101); providers must retain medical record documentation supporting medical necessity per the LCD.
When billing for services that are not covered, the claim must include the appropriate modifier to indicate non-coverage status.
When a second provider bills a diagnostic interview for a beneficiary they are seeing for the first time, documentation should support that it is the provider's first encounter with the beneficiary.
No specific documentation requirements are stated in this CPB.

Diagnostic interview codes (e.g., CPT 90791/90792) are indicated for the initial evaluation of a beneficiary, and a second provider seeing the beneficiary for the first time may report diagnostic interview codes for that initial encounter.
CPT code 96105 is indicated for formal evaluation of aphasia using a standardized instrument (for example, the Boston Diagnostic Aphasia Examination).
HCPCS codes G0017 and G0018 are appropriate for services provided in non-facility places of service other than Office.
General coverage principle: Aetna medical benefit plans provide coverage only for treatment of illness or injury (check individual benefit plan descriptions for specific covered services).
None specific for work hardening programs — Aetna does not cover work hardening programs when provided for occupational/return-to-work/reintegration or other vocational purposes, because these are considered vocational training and not treatment of illness or injury.
Diagnostic psychiatric interview is indicated for initial or periodic diagnostic evaluation of a patient with suspected or diagnosed psychiatric illness.

NOVITAS-JH-L35101, Psychiatric Codes

NOVITAS-JL-L35101, Psychiatric Codes

A57130, Billing and Coding: Psychiatric Codes

AETNA-CPB-0198, Work Hardening Programs

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