Does A52.00 require prior authorization?

No, A52.00 does not require prior authorization (high confidence). Code is covered without prior authorization.

`A52.00` — Cardiovascular syphilis, unspecified

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

When a limited or follow-up echocardiogram is performed, document the targeted cardiac problem/region and bill using the appropriate CPT code (93308 or 93321).
If the study is a screening exam, document and bill with the appropriate screening ICD-10 code; document any abnormal findings and use the resulting diagnosis for subsequent billing when applicable.
Document use of ultrasound contrast enhancement and its supplies separately when billed, and do not submit separate claims for diagnostic injection services integral to the contrast procedure.
Follow the Local Coverage Determination L37379 and include documentation sufficient to support medical necessity when multiple imaging studies are billed.

Follow-up or limited transthoracic echocardiography performed to evaluate a single specified cardiac problem or region must be billed with CPT 93308.
Limited Doppler/follow-up echocardiographic studies (for targeted velocity or gradient assessment) should be billed with CPT 93321 (e.g., tricuspid regurgitant velocity to estimate pulmonary artery systolic pressure or sequential transmitral velocity in mitral stenosis).
Contrast echocardiography is covered to evaluate myocardial ischemia, quantify myocardial perfusion during stress, identify the area at risk during acute myocardial infarction, determine success of reperfusion interventions, and assess myocardial viability.
Transthoracic echocardiogram (TTE) is covered to evaluate ventricular function and cardiomyopathies in individuals with signs and/or symptoms suggestive of ventricular dysfunction.
TTE is covered for hypertensive cardiovascular disease when hypertension is accompanied by clinical evidence of heart disease (HTN alone without signs/symptoms is not covered).
TTE is covered for evaluation and complication assessment in acute myocardial infarction and coronary insufficiency when clinical findings indicate myocardial dysfunction.

CIGNA-0510 — Transthoracic Echocardiography in Adults - (0510)

A56625 — Billing and Coding: Echocardiography

L37379 — Echocardiography

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