B17.2 — Acute hepatitis E
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- This billing and coding article provides guidelines that complement Local Coverage Determination L34415 for CT of the abdomen and pelvis; consult LCD L34415 for specific coverage indications, limitations, and documentation requirements.
- CT scans must be performed on CT equipment models that are FDA-known and in full market release phase.
- Clinical evidence supporting diagnosis (e.g., laboratory or diagnostic test results, such as pathogen identification by appropriate testing) and medical records showing clinical severity and rationale for inhaled ribavirin therapy.
- Records demonstrating treatment regimen and administration details as applicable (the CPB cites recommended dosing regimen: 20 mg/mL Virazole in SPAG-2 unit with continuous aerosol administration 12-18 hours/day for 3-7 days as recommended dosing information from Virazole prescribing information).
Key Coverage Criteria
- CT abdomen is medically necessary to evaluate abdominal pain.
- CT abdomen is medically necessary to evaluate known or suspected abdominal masses or fluid collections.
- CT abdomen is medically necessary for evaluation of primary or metastatic malignancies in the abdomen.
- CT abdomen is medically necessary to evaluate abdominal inflammatory processes.
- CT abdomen is medically necessary to evaluate abnormalities of abdominal vascular structures.
- CT abdomen is medically necessary to evaluate abdominal trauma.
4 Active Policies
A57802 — Billing and Coding: Hepatic (Liver) Function Panel
AETNA-CPB-0155 — Ribavirin (Virazole) Inhalation
A56421 — Billing and Coding: CT of the Abdomen and Pelvis
L34415 — CT of the Abdomen and Pelvis
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.