Does E02 require prior authorization?

No, E02 does not require prior authorization (high confidence). Code is covered without prior authorization.

`E02`, Subclinical iodine-deficiency hypothyroidism

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

An interpretation and report must be a complete, separately identifiable written report addressing findings, relevant clinical issues, comparative data (when available), and must be included in the medical record.
The patient's medical record must be legible and clearly document the reasonableness and necessity of the ECG and show that the service was necessary for at least one covered condition in the policy.
A laboratory or portable X‑ray supplier that furnishes an ECG must retain the referring physician’s written order and the identity of the employee who took the tracing.
An ECG furnished on an emergency basis by a laboratory or portable X‑ray supplier requires a physician to be in attendance at the time the service was performed or immediately thereafter to support payment.
Supportive documentation must justify multiple ECGs for acute ischemic episodes or unstable conditions and demonstrate medical necessity when more than one ECG is performed on the same day or more than once annually.
All documentation supporting MAC must be maintained in the patient's medical record, be legible, include complete patient identification and dates of service, and be made available to the contractor upon request.

An ECG is covered when the result is relevant to the management, diagnosis, or treatment of the patient.
A separate ECG on the same day as a cardiac stress test is payable only when it provides additional clinically necessary information beyond the stress test (e.g., to rule out acute myocardial infarction prior to performing the stress test).
Rhythm ECGs are covered when used to evaluate signs or symptoms suggesting a cardiac rhythm disorder.
Home-based ECG services (including additional payment above the base ECG amount for transportation) are covered when there is a documented medical need to perform the ECG in the patient's home, typically for homebound or bed-confined patients.
A second professional component (PC) interpretation may be paid when a second physician’s substantially greater expertise is necessary and reasonable to clarify a questionable or confusing ECG finding and contributes substantially to diagnosis or treatment.
Monitored Anesthesia Care (MAC) is medically necessary when the patient has one or more documented diagnoses listed as supporting medical necessity (e.g., F91.9, G97.81, T81.9XXA, T88.8XXA, F79) and the diagnosis is matched to the anesthesia/CPT/HCPCS procedure performed.

NOVITAS-JH-L35049, Monitored Anesthesia Care

NOVITAS-JL-L35049, Monitored Anesthesia Care

A57361, Billing and Coding: Monitored Anesthesia Care

AETNA-CPB-0327, Infertility

A57326, Billing and Coding: Electrocardiograms

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