Does T46.994A require prior authorization?

No, T46.994A does not require prior authorization (high confidence). Code is covered without prior authorization.

`T46.994A` — Poisoning by other agents primarily affecting the cardiovascular system, undetermined, initial encounter

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

This article provides billing/coding guidelines that complement Local Coverage Determination L34417 for CT of the head; consult LCD L34417 for specific coverage, coding, and documentation requirements.
Document the medical necessity for the chosen test frequency in the medical record (preferably on the test report).
Document that any applicable physician supervision requirement is met (preferably on the test report).
Medical record must document a clinical diagnosis and the specific reason for the study to substantiate medical necessity.

Stress testing (exercise or pharmacological, including stress echocardiography) is covered when the results will potentially affect the patient’s treatment plan.
An initial follow-up stress test may be indicated several months after myocardial infarction (MI), coronary artery bypass graft (CABG), or percutaneous transluminal coronary angioplasty (PTCA) when clinically appropriate.
A second follow-up stress test may be indicated approximately one year after the first follow-up test following MI, CABG, or PTCA when clinically appropriate.
Patients with silent coronary disease (no reliable signs or symptoms) may require stress testing as often as annually when clinically indicated.
Patients who present with reliable symptoms or signs of coronary artery disease (e.g., angina pectoris) may require stress testing as dictated by symptoms but typically will not require annual testing.
ICD-10-CM Codes that Support Medical Necessity — Group 1: The following list of ICD-10-CM codes applies to cardiovascular stress testing CPT codes 93015, 93016, 93017, 93018, 93350, 93351 93352 and J0153.

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

J05

A57473 — Billing and Coding: Allergy Testing

J05

L36402 — Allergy Testing

J05

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

J05

A57472

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