Does Z95.810 require prior authorization?

No, Z95.810 does not require prior authorization (high confidence). Covered without prior authorization.

`Z95.810`, Presence of automatic (implantable) cardiac defibrillator

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
Every page of the record must be legible and include appropriate patient identification information, including complete name and dates of service.
The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the patient's care.
The submitted medical record must support the use of the selected ICD-10-CM code(s).

When billing Medicare Part B for analysis of a Wearable Defibrillator System, report CPT code 93292.
Report CPT codes 93260, 93261, and 93279-93292 when performing the corresponding cardiac rhythm device evaluation procedures (reported per procedure).
Interrogation (in-person, remote/web-based, or device transmission) of implantable or wearable cardioverter defibrillators (ICDs) is covered when medically necessary and supported by documentation of the ordering provider's assessment, relevant history, and pertinent test results.
In-person interrogation is covered for evaluation of clinical symptoms or device issues and may be performed as clinically appropriate based on symptomatology.
Remote interrogation services (including internet/web-based surveillance) are covered as a surveillance modality when documented and billed per applicable coding rules.
An ECG is covered when the result is relevant to the management, diagnosis, or treatment of the patient.

CGS-J15-L34087, Surveillance of Implantable or Wearable Cardioverter Defibrillators (ICDs): Office, Hospital, Web, or Non-Web Based

J15

CGS-J15-L40243, Temporary Nontherapeutic Ambulatory Cardiac Monitoring Devices

J15

CGS-J15-L40244, Temporary Nontherapeutic Ambulatory Cardiac Monitoring Devices

J15

CGS-J18-L40243, Temporary Nontherapeutic Ambulatory Cardiac Monitoring Devices

J18

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