Does Z94.1 require prior authorization?

No, Z94.1 does not require prior authorization (high confidence). Covered without prior authorization.

`Z94.1`, Heart transplant status

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

A formal physician report documenting conduct and evaluation of cardiac catheterization procedures is required for reimbursement.
Swan-Ganz catheterization results may be recorded in progress notes rather than a formal report when performed for ongoing monitoring.
Extra-cardiac angiographic services performed during cardiac catheterization must be specifically requested by the treating physician and documented in the patient's medical record with anticipated therapeutic implications.
Reasons for delaying a indicated interventional procedure (when diagnostic catheterization and intervention are separated) must be documented in the medical record.

Right heart catheterization is indicated for endocarditis requiring valvular surgical repair.
Right heart catheterization is indicated for suspected rejection of a transplanted heart.
Right heart catheterization is indicated for suspected pericardial tamponade or constriction.
Right heart catheterization is indicated to evaluate valvular heart disease.
Right heart catheterization is indicated to evaluate congestive heart failure.
Right heart catheterization is indicated to evaluate congenital heart disease.

CGS-J15-L34337, Transesophageal Echocardiography (TEE)

J15

CGS-J15-L40139, MolDX: Molecular Testing for Solid Organ Allograft Rejection

J15

CGS-J15-L33960, Cardiovascular Nuclear Medicine

J15

CGS-J15-L34338, Transthoracic Echocardiography (TTE)

J15

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