Does A54.42 require prior authorization?

No, A54.42 does not require prior authorization (high confidence). Code is covered without prior authorization.

`A54.42` — Gonococcal arthritis

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Claims for arthroscopic lavage/drainage for infection should be billed using CPT 29871 and reference NCD 150.9.
Policy cites NCD 150.9 and CMS Change Request 3281; any additional documentation or contractor-specific requirements are determined by the Medicare contractor.
Submit the appropriate CPT® or PLA code (or CPT® 87999 if no specific code) with each claim and ensure the CPT/HCPCS code describes the service performed.
Include ICD-10-CM diagnosis code(s) that support medical necessity on every claim and retain medical record documentation that supports the selected diagnosis codes.

All other indications for arthroscopic lavage of the knee are subject to Medicare contractor discretion.
Arthroscopic lavage and drainage of the knee for infection (septic arthritis) is covered and described by CPT 29871 per NCD 150.9.
Molecular syndromic infectious disease panels are covered when billed with the appropriate proprietary CPT®/PLA code (or CPT® 87999 if no specific code exists) and accompanied by ICD-10-CM diagnosis codes that support medical necessity documented in the patient record.
FDA-approved or cleared molecular infectious disease tests performed consistent with their intended use labeling are covered without a DEX Z-Code and Technical Assessment when billed with appropriate ICD-10-CM diagnosis codes and supporting documentation.
Expanded (>5 pathogens) respiratory (RP/PNP) and gastrointestinal (GI) panels are covered if billed from place of service (POS) 19, 21, 22, or 23, or if ordered by an appropriate specialist depending on beneficiary immune status and the specialist is diagnosing/treating the beneficiary.
For immune-compromised beneficiaries, expanded panels (RP/PNP/GI/other panels) are covered when ordered by a specialist in Infectious Diseases, Oncology, Transplant, Pulmonology (for RP/PNP), or Gastroenterology (for GI) who is diagnosing and treating the beneficiary.

L39044 — MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

J05

A58761 — Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

J05

A58720 — Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

A58726 — Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

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