Does T78.3XXA require prior authorization?

No, T78.3XXA does not require prior authorization (high confidence). Code is covered without prior authorization.

`T78.3XXA` — Angioneurotic edema, initial encounter

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

All documentation must be maintained in the patient's medical record and made available to the contractor upon request; every page must be legible and include appropriate patient identification (e.g., complete 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 medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
Prior to testing there must be evidence that a history was obtained indicating possible allergy and that attempts were made to narrow the area of investigation so that the minimal necessary skin tests were selected.

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.
Follow-up or limited transthoracic echocardiography performed to evaluate a single specified cardiac problem or region must be billed with CPT 93308.
Limited Doppler/follow-up echocardiographic studies (for targeted velocity or gradient assessment) should be billed with CPT 93321 (e.g., tricuspid regurgitant velocity to estimate pulmonary artery systolic pressure or sequential transmitral velocity in mitral stenosis).
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.

A57473 — Billing and Coding: Allergy Testing

J05

L36402 — Allergy Testing

J05

A56844 — Billing and Coding: RAST Type Tests

J06

L33591 — RAST Type Tests

J06

L33261 — Allergy Testing

J09

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