Does R50.9 require prior authorization?

No, R50.9 does not require prior authorization (high confidence). Code is covered without prior authorization.

Verity

`R50.9` — Fever, unspecified

ICD-10-CM

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Documentation Required

Enter specific test verbiage in the claim narrative field: for pre-1/1/2018 Zika rRT-PCR enter 'Zika PCR'; for pre-1/1/2018 Trioplex enter 'Zika Trioplex'; for other tests enter test-appropriate verbiage, using Part A Loop 2300/NTE or Form Locator 80 (CMS 1450) or Part B Loop 2400/SV101-7 or Item 19 (CMS 1500) as applicable.
Claims must include at least one of the specified ICD-10 diagnosis codes on the claim to support Zika-related test billing.
Laboratories must have and make available their FDA Emergency Use Authorization (EUA) for the respective test upon Noridian request.
PRNT confirmatory testing, if indicated, is performed by CDC or CDC-designated labs and the PRNT test result/process is not billed to Medicare (do not submit PRNT claims).

Key Coverage Criteria

For dates of service on or after 1/1/2018, bill Zika rRT-PCR using CPT 87662 when testing is ordered and the claim includes at least one of the listed ICD-10 diagnosis codes and testing follows FDA and CDC guidelines.
For dates of service prior to 1/1/2018, bill Zika rRT-PCR using CPT 87999 and enter 'Zika PCR' in the claim narrative field when testing is ordered and the claim includes at least one of the listed ICD-10 diagnosis codes.
For dates of service on or after 1/1/2018, bill Zika virus IgM testing using CPT 86794 when testing is ordered and the claim includes at least one of the listed ICD-10 diagnosis codes.
Bill Dengue rRT-PCR using CPT 87798 when Dengue testing is ordered and the claim includes at least one of the listed ICD-10 diagnosis codes.
Bill Chikungunya rRT-PCR using CPT 87798 when Chikungunya testing is ordered and the claim includes at least one of the listed ICD-10 diagnosis codes.
If both Dengue and Chikungunya rRT-PCR testing are performed on the same date of service, bill once using CPT 87801.

20 Active Policies

A58761 — Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

J05

L39044 — MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

J05

L33577 — Transthoracic Echocardiography (TTE)

J06

A56781 — Billing and Coding: Transthoracic Echocardiography (TTE)

J06

Have a follow-up question?

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

This billing and coding article provides guidelines that complement Local Coverage Determination L34415 for CT of the abdomen and pelvis; consult LCD L34415 for specific coverage indications, limitations, and documentation requirements.

Claims for stress tests performed as preoperative evaluation of asymptomatic, moderate-risk patients must include medical record documentation of at least one of: diabetes mellitus with complications; peripheral vascular disease; aortic aneurysm; or cerebrovascular disease.

AETNA-CPB-0650 — Polymerase Chain Reaction Testing: Selected Indications

ANTHEM-CG-LAB-24 — CG-LAB-24 Outpatient Urine Culture

ANTHEM-CG-LAB-20 — CG-LAB-20 Thyroid Testing

A55326 — Billing and Coding: Zika Virus Testing by PCR and ELISA Methods

A56421 — Billing and Coding: CT of the Abdomen and Pelvis

A56476 — Billing and Coding: Cardiac Radionuclide Imaging

A56625 — Billing and Coding: Echocardiography

A57306 — Billing and Coding: Transthoracic Echocardiography (TTE)

A58575 — Billing and Coding: Respiratory Pathogen Panel Testing

A58577 — Billing and Coding: Respiratory Pathogen Panel Testing

A58710 — Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

A58720 — Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

A58726 — Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

A58741 — Billing and Coding: Respiratory Pathogen Panel Testing

A58747 — Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

A59318 — Billing and Coding: Positron Emission Tomography (PET) Scan for Inflammation and Infection

R50.9 — Fever, unspecified