Does R00.1 require prior authorization?

No, R00.1 does not require prior authorization (high confidence). Code is covered without prior authorization.

`R00.1` — Bradycardia, unspecified

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
Diagnostic test claims must include the test result if known; if result is not available, report the symptoms that prompted the test.
The patient medical record must include the ordering provider's assessment related to the patient's complaint, relevant medical history, and results of pertinent tests/procedures.
Office visit records and operative reports must be signed and dated; all services ordered or rendered to Medicare beneficiaries must be signed.

Preoperative cardiac stress testing with radionuclide imaging for asymptomatic patients deemed at moderate risk is covered only if the medical record documents at least one of the following: diabetes mellitus with complications; peripheral vascular disease; aortic aneurysm; or cerebrovascular disease.
When billing Medicare Part B for analysis of a Wearable Defibrillator System, report CPT code 93292.
Report CPT codes 93260, 93261, and 93279-93292 when performing the corresponding cardiac rhythm device evaluation procedures (reported per procedure).
Coverage and billing for cardiac event detection should follow the clinical indications and medical necessity criteria specified in Local Coverage Determination L34573.
An ECG is covered when the result is relevant to the management, diagnosis, or treatment of the patient.
A separate ECG on the same day as a cardiac stress test is payable only when it provides additional clinically necessary information beyond the stress test (e.g., to rule out acute myocardial infarction prior to performing the stress test).

A57476 — Billing and Coding: Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring)

J05

L34636 — Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring)

J05

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

J09

L39492 — Ambulatory Electrocardiograph (AECG) Monitoring

J09

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