Does B39.5 require prior authorization?

No, B39.5 does not require prior authorization (high confidence). Code is covered without prior authorization.

`B39.5` — Histoplasmosis duboisii

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

The submitted medical record must support the selected ICD-10-CM code(s), and the submitted CPT/HCPCS code must accurately describe the service performed.
The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
When billing CPT 84999 for the listed tests, include a note identifying the specific test in the Remarks (Part A) or Narrative (Part B) area of the claim.
All documentation must be maintained in the patient's medical record, be legible, include patient identification (e.g., complete name) and dates of service, and be made available to the contractor upon request.

For tests that currently lack specific CPT codes (functional intracellular analysis and total antioxidant function), bill using CPT 84999 and add a note identifying which test was performed in the Remarks area for Part A claims and the Narrative area for Part B claims.
Coverage and reasonable/necessary determinations for assays for vitamins and metabolic function are governed by LCD L34914 and claims must meet that LCD's requirements to be covered.
Cardiac catheterization and coronary angiography are covered when the medical record documents medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests that support the procedure.
Scanning computerized ophthalmic diagnostic imaging (SCODI) is covered when the service meets the medical necessity criteria and is included within Local Coverage Determination L34380.
SCODI (CPT 92133) is covered when performed to evaluate or monitor optic nerve damage/optic neuropathy.
SCODI (CPT 92134) is covered for management of retinal diseases including wet age-related macular degeneration/choroidal neovascularization, macular edema, diabetic retinopathy (proliferative and nonproliferative), branch retinal vein occlusion, central retinal vein occlusion, and cystoid macular edema.

L34760 — Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

J05

L34658 — Vitamin D Assay Testing

J05

A56916 — Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)

J05

A57484 — Billing and Coding: Vitamin D Assay Testing

J05

A56537

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