Does O09.211 require prior authorization?

No, O09.211 does not require prior authorization (high confidence). Code is covered without prior authorization.

`O09.211` — Supervision of pregnancy with history of pre-term labor, first trimester

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

In the narrative section of the claim form (Part A Loop 2300/NTE for EMC claims, or Form Locator 80 on the CMS 1450 form or paper claims, Part B Loop 2400/SV101-7 for EMC claims, or Item 19 on the CMS 1500 form for paper claims) please enter the following verbiage (without quotation marks) as it pertains to the respective tests.
For Claims submitted prior to 1/1/2018 use the following guidance: 1. Zika rRT-PCR only – Use CPT® 87999 and enter “Zika PCR” ... 2. Trioplex rRT-PCR – Use CPT® 87999 and enter “Zika Trioplex”.
Noridian retains the right to be sent a copy of the respective lab’s EUA upon request.
Billing must be based on the patient's Plan of Care (POC) or other available medical records; dialysis sessions listed in the POC that were not furnished must not be billed.

Each dialysis session performed for an ESRD patient must be reported on a separate line for dates of service on or after 2007-04-01.
When the hemodialysis prescription is three times per week and each session is furnished, bill each session as CPT 90999 with no modifier; these sessions will be paid as routine conventional dialysis.
Dialysis sessions furnished in addition to three per week that have medical documentation supporting reasonable and necessary need should be billed as CPT 90999 with the KX modifier for consideration of additional payment.
Report each hemodialysis session for ESRD patients on a separate line for claims with dates of service on or after April 1, 2007.
When hemodialysis prescription is 3 sessions per week and each session is furnished, bill each session as CPT 90999 with no modifier for routine conventional dialysis.
For dialysis sessions beyond 3 sessions per week that are reasonable and necessary and supported by medical documentation, bill each additional session as CPT 90999 with modifier KX to be considered for additional payment.

L37537 — Frequency of Hemodialysis

J05

A55703 — Billing and Coding: Frequency of Hemodialysis

J05

A55672 — Billing and Coding: Frequency of Hemodialysis

J06

L37475 — Frequency of Hemodialysis

J06

L37564 — Frequency of Hemodialysis

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