Does T65.94XS require prior authorization?

No, T65.94XS does not require prior authorization (high confidence). Code is covered without prior authorization.

`T65.94XS` — Toxic effect of unspecified substance, undetermined, sequela

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.
Maintain a legible medical record for each patient that includes complete patient identification (e.g., full name, dates of service) and is available to the contractor upon request.
Medical records 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 use of the selected ICD-10-CM code(s) and the medical necessity of the cystatin C test as directed in the related LCD (L37581).

Cystatin C measurement is covered when performed on an adult (age >=18) patient with a creatinine-based eGFR of 45–59 ml/min/1.73 m2 and who does not have markers of kidney damage.
Cystatin C measurement is covered when the medical record documents a clear rationale that creatinine-based eGFR estimates are thought to be inaccurate and that more accurate knowledge of GFR will affect clinical decision-making or the patient’s plan of care.
Cystatin C measurement is covered for adult patients (age >=18) with creatinine-based eGFR 45–59 ml/min/1.73 m2 who do not have markers of kidney damage.
Cystatin C measurement is covered when documentation shows creatinine-based GFR estimates are believed to be inaccurate and more accurate GFR knowledge will affect clinical decision making or the patient's plan of care.
Cystatin C measurement is covered when medical record documents an adult patient (>=18 years) with a creatinine-based eGFR of 45–59 ml/min/1.73 m2 and no markers of kidney damage.
Cystatin C measurement is covered when the ordering documentation demonstrates that creatinine-based GFR estimates are believed to be inaccurate and more accurate GFR knowledge will affect clinical decision-making or the patient's plan of care.

ANTHEM-CG-LAB-29 — CG-LAB-29 Gamma Glutamyl Transferase Testing

A56612 — Billing and Coding: CT of the Head

A56948 — Billing and Coding: Lab: Cystatin C Measurement

A56988 — Billing and Coding: Cystatin C Measurement

A57643 — Billing and Coding: Lab: Cystatin C Measurement

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