T63.484A — Toxic effect of venom of other arthropod, undetermined, initial encounter
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Maintain all documentation in the patient's medical record and make it available to the contractor upon request.
- Every page of the medical record must be legible and include patient identification information (e.g., full name, dates of service).
- The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
- The submitted medical record must support the selected ICD-10-CM code(s) used for billing.
Key Coverage Criteria
- Allergen immunotherapy is covered only when it meets the reasonable and necessary requirements specified in Local Coverage Determination (LCD) L36240.
- Allergy testing is covered when the medical record documents a history indicating the possible presence of allergy and the clinician selected a minimal number of tests/antigens based on patient-specific history and physician examination.
- Allergy testing is covered when the medical record documents the test(s) used, the interpretation(s), and objective measurement of reaction size (wheal and erythema in mm) or a standardized in vivo grading system.
- RAST type tests are covered when medically necessary and supported by the related Local Coverage Determination (LCD) and current medical literature or standards of practice.
- CPT code 86003 (RAST type test) is covered when billed for diagnostic testing, subject to the stated annual frequency limit.
- An ECG is covered when the result is relevant to the management, diagnosis, or treatment of the patient.
19 Active Policies
A56844 — Billing and Coding: RAST Type Tests
J06
L33591 — RAST Type Tests
J06
L37800 — Allergen Immunotherapy
J09
A57531 — Billing and Coding: Allergy Testing
J09
A57678 — Billing and Coding: Allergen Immunotherapy
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.