Does R00.9 require prior authorization?

No, R00.9 does not require prior authorization (high confidence). Code is covered without prior authorization.

`R00.9` — Unspecified abnormalities of heart beat

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

This billing/coding guideline complements LCD L33459 (Computerized Axial Tomography (CT), Thorax); follow the LCD for clinical coverage and any required documentation or prior authorization rules.
When a limited or follow-up echocardiogram is performed, document the targeted cardiac problem/region and bill using the appropriate CPT code (93308 or 93321).
If the study is a screening exam, document and bill with the appropriate screening ICD-10 code; document any abnormal findings and use the resulting diagnosis for subsequent billing when applicable.
Document use of ultrasound contrast enhancement and its supplies separately when billed, and do not submit separate claims for diagnostic injection services integral to the contrast procedure.

Follow-up or limited transthoracic echocardiography performed to evaluate a single specified cardiac problem or region must be billed with CPT 93308.
Limited Doppler/follow-up echocardiographic studies (for targeted velocity or gradient assessment) should be billed with CPT 93321 (e.g., tricuspid regurgitant velocity to estimate pulmonary artery systolic pressure or sequential transmitral velocity in mitral stenosis).
Transthoracic echocardiography (TTE) is covered when the patient's medical record documents medical necessity consistent with the LCD indications for TTE.
Contrast (contrast-enhanced) echocardiography is covered when conventional echocardiographic studies were inconclusive and contrast enhancement is needed to complete diagnostic evaluation.
Repeat echocardiographic studies are covered to monitor changes in cardiac structure or function when there is a change in clinical status or when disease progression is suspected.
CT thorax is covered for diagnosis and/or staging of neoplastic and hematologic processes arising in or involving the thorax.

L33577 — Transthoracic Echocardiography (TTE)

J06

A56781 — Billing and Coding: Transthoracic Echocardiography (TTE)

J06

ANTHEM-CG-MED-74 — CG-MED-74 Implantable Ambulatory Event Monitors and Mobile Cardiac Telemetry

ANTHEM-CG-MED-40 — CG-MED-40 External Ambulatory Cardiac Monitors

ANTHEM-CG-LAB-30 — CG-LAB-30 Outpatient Laboratory-based Blood Glucose Testing

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