Does 0626T require prior authorization?

No, 0626T does not require prior authorization (high confidence). Code is covered without prior authorization.

`0626T`

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

The Coronary CT Angiography (CCTA) report must be included in the patient's record.
The medical record must include a history and physical exam sufficient to assess pre-test probability for coronary artery disease (CAD).
Document a description of symptoms consistent with stable ischemic heart disease when applicable.
Document the clinical findings that led to the initial performance of the CCTA, and ensure the CCTA is completed and interpreted prior to performing AI-QCT/AI-CPA.

AI-QCT/AI-CPA is covered only for patients who have a medically indicated CCTA and meet all requirements of LCD L33947 for Cardiac CT (CCT) and Coronary CT Angiography (CCTA).
AI-QCT/AI-CPA will be performed only after the base CCTA study has been completed and interpreted.
Patient must have a medically indicated coronary CT angiography (CCTA) that meets all requirements of the related LCD (see CCTA LCD L33423).
AI-QCT/AI-CPA may only be performed as a post‑procedure analysis after the base CCTA has been completed and interpreted.
The clinical indication for addition of AI-QCT/AI-CPA must be documented in the medical record prior to billing the service.
Patient must have a medically indicated coronary CT angiography (CCTA) and meet all requirements per LCD L33559 prior to AI-QCT/AI-CPA analysis.

L39913 — Artificial Intelligence Enabled CT Based Quantitative Coronary Topography (AI-QCT)/Coronary Plaque Analysis (AI-CPA)

J05

A59813 — Billing and Coding: Artificial Intelligence Enabled CT Based Quantitative Coronary Topography (AI-QCT)/Coronary Plaque Analysis (AI-CPA)

J05

L35121 — Coronary Computed Tomography Angiography (CCTA)

J05

L39863 — Artificial Intelligence Enabled CT Based Quantitative Coronary Topography (AI-QCT)/Coronary Plaque Analysis (AI-CPA)

J06

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