J1160, Injection, digoxin, up to 0.5 mg
HCPCS/CPT
Prior Authorization
Prior Auth Required
Conditional coverage; review criteria to confirm PA need (medium confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Document the clinical indication for testing (e.g., symptoms/ECG of toxicity, medication changes, renal/organ dysfunction, suspected overdose, or need to assess compliance) in the medical record.
- If an accurate history of digoxin use is unobtainable, document an acceptable cardiac diagnosis that justifies testing.
Key Coverage Criteria
- Obtain digoxin level in suspected accidental or intentional digoxin overdose.
- Obtain digoxin level for patients with signs, symptoms, or ECG findings suggestive of digoxin toxicity.
- Obtain digoxin level for patients receiving digoxin who are taking medications known to influence digoxin absorption, bioavailability, distribution, or elimination.
- Obtain digoxin level for patients with impaired renal, hepatic, gastrointestinal, or thyroid function while on digoxin therapy.
- Obtain digoxin level for patients with pH abnormalities or electrolyte disturbances while receiving digoxin.
- Obtain digoxin level for patients with unstable cardiovascular status, including myocarditis, who are receiving digoxin.
1 Active Policy
NCD103, Digoxin Therapeutic Drug Assay
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