Does Z94.3 require prior authorization?

No, Z94.3 does not require prior authorization (high confidence). Covered without prior authorization.

`Z94.3`, Heart and lungs transplant status

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Medical records must document the indication(s) supporting use of IVIG for each claim.
For indications where routine IVIG use is not indicated, the medical record must document prior interventions that were unsuccessful or reasons those interventions were not tolerated.
Documentation must support objective clinical response to IVIG for continued coverage.
Medical records must be made available to the Contractor upon request to substantiate coverage and payment.

IVIG is covered only for indications specified as covered in the related Local Coverage Determination (LCD) and when medical necessity criteria in that LCD are met.
Molecular testing for detection or monitoring of solid organ allograft rejection is covered when the patient and clinical situation meet the coverage criteria of the referenced MolDx LCD/policy.
AlloMap (CareDx) gene expression profile performed on blood is covered for surveillance/assessment of heart transplant rejection when coverage criteria are met.
AlloSure (CareDx) targeted NGS measuring percent donor-derived cell-free DNA from blood is covered for assessment of kidney, heart, and lung transplant injury/rejection when coverage criteria are met.
AlloCare (CareDx) AlloSure Heart plus AlloMap Heart performed on the same blood sample is covered for heart transplant assessment when coverage criteria are met.
Prospera (Natera) multiplex PCR–NGS measuring percent donor-derived cell-free DNA from blood is covered for assessment of kidney, heart, and lung transplant injury/rejection when coverage criteria are met.

CGS-J15-L33959, Cardiac Catheterization and Coronary Angiography

J15

CGS-J15-L38582, MolDX: Molecular Testing for Solid Organ Allograft Rejection

J15

CGS-J15-L34337, Transesophageal Echocardiography (TEE)

J15

CGS-J15-L39038, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

J15

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