Does I97.89 require prior authorization?

No, I97.89 does not require prior authorization (high confidence). Code is covered without prior authorization.

`I97.89` — Other postprocedural complications and disorders of the circulatory system, not elsewhere classified

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medical record documentation must support the specific diagnosis corresponding to one of the listed ICD-10-CM codes and explicitly state that IABP is not expected to be sufficient.
Clinical documentation should indicate the life-threatening nature (e.g., cardiogenic shock, multi-organ failure, or intra/postoperative circulatory collapse) and any supporting hemodynamic or organ-failure data.
Medical record must document diagnosis supporting one of the three life‑threatening situations and cite the relevant ICD‑10‑CM code(s).
Medical record must document that external counterpulsation (IABP) is not expected to be sufficient for the patient.

Percutaneous endovascular cardiac assist device is covered for cardiogenic shock (ICD-10-CM R57.0) when intraaortic balloon pump (IABP) is not expected to be sufficient.
Percutaneous endovascular cardiac assist device is covered for severe decompensated heart failure with threatening multi-organ failure when documented by one of the ICD-10-CM codes I50.21, I50.23, I50.41, I50.43, I97.110, I97.111, I97.130, or I97.131 and when IABP is not expected to be sufficient.
Percutaneous endovascular cardiac assist device is covered for intraoperative or postoperative circulatory system complications/disturbances documented by ICD-10-CM codes I97.790, I97.791, I97.88, or I97.89 when IABP is not expected to be sufficient.
Percutaneous endovascular cardiac assist device is covered for cardiogenic shock when external counterpulsation (IABP) is not expected to be sufficient.
Percutaneous endovascular cardiac assist device is covered for severe decompensated heart failure with threatening multi-organ failure when external counterpulsation (IABP) is not expected to be sufficient.
Percutaneous endovascular cardiac assist device is covered for intraoperative or postoperative complications/disturbances of the circulatory system when external counterpulsation (IABP) is not expected to be sufficient.

L33577 — Transthoracic Echocardiography (TTE)

J06

A56781 — Billing and Coding: Transthoracic Echocardiography (TTE)

J06

A57056 — Billing and Coding: Aortography and Peripheral Angiography

J09

L36767 — Aortography and peripheral angiography

J09

A56682

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