Does 92938 require prior authorization?

No, 92938 does not require prior authorization (high confidence). Code is covered without prior authorization.

`92938`

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

The medical record must document medical necessity for the PCI, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Each claim must include ICD-10-CM diagnosis code(s) that best describe the patient's condition and the reason for the service; claims lacking ICD-10-CM codes will be returned.
Documentation must be in the format of a procedure note and must state the indications, any unusual clinical circumstances, and the details and results of the intervention.
Angiographic documentation (film or digital) and intravascular sonographic recordings must be maintained in the medical record and made available upon request.

Percutaneous coronary intervention (PCI) using angioplasty, atherectomy, or stenting (CPT 92920-92944) on coronary arteries is covered when medically necessary and documented in the medical record.
If a single contiguous lesion extends across more than one target vessel but can be revascularized with a single bridging intervention, the procedure is reported (and covered) as a single-vessel PCI (example: single left main stent reported as 92928).
All PCI performed in all segments (proximal, mid, distal) of a single major coronary artery through the native coronary circulation are covered and reported with one code.
If a single lesion extends from one target vessel into another but can be revascularized with a single bridging intervention, report it with a single code (CPT 92928).
CPT codes 92920-92944 describe percutaneous revascularization (PCI) for occlusive disease of coronary vessels, including major coronary arteries, coronary artery branches, and coronary artery bypass grafts.
PCI codes include angioplasty (balloon, cutting, wired, cryoplasty), atherectomy (directional, rotational, laser), and stenting (balloon-expandable, self-expanding, bare metal, drug-eluting, covered).

A57479 — Billing and Coding: Percutaneous Coronary Interventions

J05

L34761 — Percutaneous Coronary Interventions

J05

A56823 — Billing and Coding: Percutaneous Coronary Intervention

J06

L33623 — Percutaneous Coronary Intervention

J06

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