Does I25.83 require prior authorization?

No, I25.83 does not require prior authorization (high confidence). Code is covered without prior authorization.

`I25.83` — Coronary atherosclerosis due to lipid rich plaque

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

The patient's medical record must include the ordering provider's assessment related to the patient's complaint for that visit.
The medical record must include relevant medical history and results of pertinent tests and procedures.
Office visit records and operative reports must be signed and dated; all services ordered or rendered to Medicare beneficiaries must be signed.
When using the -GA modifier and ABN, Form CMS-R-131 must be signed by the beneficiary (or properly witnessed if the beneficiary refuses to sign) to indicate acceptance of payment responsibility.

For services that require a referring or ordering physician, the claim must report the referring/ordering physician's name and NPI.
Claims must include a valid ICD-10-CM diagnosis code that best describes the patient's condition for which the service was performed; otherwise the claim will be returned as incomplete under SSA Section 1833(e).
For diagnostic tests, the claim should report the test result if known, otherwise report the symptoms that prompted the test.
If a service is likely to be non-covered, an Advance Beneficiary Notice (ABN) may be used and the appropriate modifier (GA, GX, GY, or GZ) should be appended to the claim as applicable.
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.
CPT code 93355 is used to report transesophageal echocardiography (TEE) performed during transcatheter intracardiac therapies.

L34761 — Percutaneous Coronary Interventions

J05

A57479 — Billing and Coding: Percutaneous Coronary Interventions

J05

L33623 — Percutaneous Coronary Intervention

J06

A56743 — Billing and Coding: Cardiovascular Nuclear Medicine

J06

A56823 — Billing and Coding: Percutaneous Coronary Intervention

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