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ICD-10-CM Z96.20, Presence of otological and audiological implant, unspecified | No Prior Auth

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`Z96.20`, Presence of otological and audiological implant, unspecified

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

The treatment goals and subsequent documentation of treatment results should specifically demonstrate that speech therapy services are contributing to such improvement.
Speech therapy must be provided in accordance with an ongoing, written plan of care that is reviewed with and approved by the treating physician and maintained in the medical record.
The plan of care must be signed by the member's attending physician and the speech therapist.
The plan of care must include the date of onset or exacerbation of the disorder/diagnosis.

Key Coverage Criteria

Z96.21 Presence of cochlear implant status
Z96.3 Presence of artificial larynx
CPT/HCPCS services covered if selection criteria are met (examples listed in the policy):
Z96.20 Presence of otological and audiological implant, unspecified
CPT 92630 - Auditory rehabilitation; pre-lingual hearing loss (covered if selection criteria are met).
CPT 92633 - Auditory rehabilitation; post-lingual hearing loss (covered if selection criteria are met).

1 Active Policy

AETNA-CPB-0243, Speech Therapy

Related Codes

92508(1 policies)92521(1 policies)92522(1 policies)92523(1 policies)92524(1 policies)92526(1 policies)92630(1 policies)92507(1 policies)

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The plan of care must include the speech therapy evaluation (assessment findings).

The plan of care must include specific long-term and short-term goals that are specific, quantifiable (measurable), and objective.