Does I5A require prior authorization?

No, I5A does not require prior authorization (high confidence). Code is covered without prior authorization.

`I5A`, Non-ischemic myocardial injury (non-traumatic)

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

ICD-10-CM diagnosis codes supporting medical necessity must be submitted with each claim and supported by documentation in the patient's medical record.
Inclusion of the KX modifier on the claim line(s) is accepted as the provider's attestation that documentation verifying further treatment beyond standard session limits is on file and meets coverage requirements; the medical record must reflect medical reasons and be available to Medicare upon request.
If CR or ICR services involve electrocardiogram (ECG) monitoring, the medical record must document performance of such monitoring.
Reported CPT/HCPCS codes must accurately capture the service performed (e.g., CPT 93798, 93797; HCPCS G0422, G0423).

Cardiac rehabilitation (CR) is covered for beneficiaries with qualifying cardiac indications (e.g., myocardial infarction within 12 months).
CR is covered for beneficiaries with stable angina as an indication for CR.
An additional 36 CR sessions (Phase IIB) may be allowed if a significant intercurrent illness or comorbidity occurs during the first 36 sessions and the program exit criteria have not been met.
A new series of 36 CR sessions may be initiated and covered after an intervening event that qualifies as an indication for CR.
Intensive Cardiac Rehabilitation (ICR) is covered for qualifying indications and may consist of up to 72 one-hour sessions over a period up to 18 weeks.
Personal history of sustained ventricular tachycardia (spontaneous or EP-induced) not associated with an acute myocardial infarction and not due to a transient or reversible cause is an indication for ICD implantation.

A56391, Billing and Coding: Implantable Automatic Defibrillators

A59270, Billing and Coding: Ambulatory Electrocardiograph (AECG) Monitoring

FIRST_COAST-L39492, Ambulatory Electrocardiograph (AECG) Monitoring

NOVITAS-L39490, Ambulatory Electrocardiograph (AECG) Monitoring

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