Does T43.655A require prior authorization?

No, T43.655A does not require prior authorization (high confidence). Code is covered without prior authorization.

`T43.655A` — Adverse effect of methamphetamines, initial encounter

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Supportive documentation evidencing the condition and treatment must be documented in the medical record and be available to the Contractor upon request.
ICD-10-CM diagnosis codes supporting the medical necessity of the service must be submitted with each claim.
High-utilization or repeat testing should include clinical justification in the record (for example, repeat testing due to unsatisfactory response to treatment) to support medical necessity.
Medical records must document the medical necessity of the serum magnesium test, including the signs, symptoms, and/or diagnosis that prompted the test.

Allergy testing for inhalant allergens is covered when medically necessary; evaluation may include up to 90 prick-puncture tests followed by up to 40 intracutaneous tests if prick/puncture results are negative.
Allergy testing for food sensitivity is covered when medically necessary and may require up to 40 percutaneous tests.
Multitest intracutaneous testing of up to 60 tests may be appropriate in lieu of prick-puncture testing for selected patients (for example, young children, older adults, or needle-phobic individuals).
Exceeding the stated testing parameters may be covered when preliminary testing failed and immunotherapy failed to control symptoms, provided documentation supports medical necessity.
ICD-10-CM Codes that Support Medical Necessity — Group 1 (covered diagnoses): D56.1 - Beta thalassemia
ICD-10-CM Codes that Support Medical Necessity — Group 1 (covered diagnoses): D57.02 - Hb-SS disease with splenic sequestration

A57472 — Billing and Coding: Allergy Immunotherapy

J05

A57473 — Billing and Coding: Allergy Testing

J05

L36408 — Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT)

J05

L36402 — Allergy Testing

J05

L40195 — Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT)

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