Does I82.601 require prior authorization?

No, I82.601 does not require prior authorization (high confidence). Code is covered without prior authorization.

`I82.601` — Acute embolism and thrombosis of unspecified veins of right upper extremity

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
Every page of the medical record must be legible and include appropriate patient identification information such as complete name and dates of service.
The record must include the legible signature of the physician or non-physician practitioner responsible for and providing the patient's care.
The submitted medical record must support the use of the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.

Coverage determinations for biomarker testing follow Local Coverage Determination L35062 and services are covered when reasonable and necessary per that LCD.
MRA (with or without contrast) is covered when it can replace a more invasive diagnostic test (e.g., contrast angiography) and thereby reduce risk to the beneficiary.
MRA is covered for diagnosis and assessment of diseases and abnormalities of the arterial, venous, and lymphatic systems at any anatomic location when reasonable and necessary for the specific patient's diagnosis or treatment.
Coverage and definition of MRA are subject to the CMS Internet-Only Manual, Pub. 100-03, Medicare NCD Manual, Chapter 1, Part 4, §220.2; MRA is considered appropriate consistent with that NCD.
Genetic (germline/hereditary) testing is medically necessary to establish a molecular diagnosis of an inheritable disease when (1) the beneficiary displays clinical features of the associated disease (carrier status or family studies excluded), (2) the test result will directly impact the beneficiary's treatment, and (3) a definitive diagnosis remains uncertain after history, physical exam, pedigree analysis, genetic counseling, and completion of conventional diagnostic studies.
Factor II (F2) and Factor V (F5) germline mutation testing are considered medically reasonable and necessary when performed for evaluation of venous thromboembolism.

A56541 — Billing and Coding: Biomarkers Overview

J12

L39063 — Pharmacogenomics Testing

J12

L35062 — Biomarkers Overview

J12

A59845 — Billing and Coding: Magnetic Resonance Angiography

A56775 — Billing and Coding: Magnetic Resonance Angiography

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