Does T82.6XXA require prior authorization?

No, T82.6XXA does not require prior authorization (high confidence). Code is covered without prior authorization.

`T82.6XXA` — Infection and inflammatory reaction due to cardiac valve prosthesis, initial encounter

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

A face-to-face encounter and a Written Order Prior to Delivery (WOPD) must be documented and obtained prior to delivery for specified HCPCS codes per Final Rule 1713 and the LCD-related Standard Documentation Requirements article.
The diagnosis code that justifies the medical need for the AED must be included on the claim.
Suppliers must use the KX modifier only if all LCD criteria are met; use GA if an ABN was obtained when criteria are not met, or GZ if no valid ABN was obtained; failure to use required modifiers will result in claim rejection.
All claims for codes K0606 and E0617 must include the KF modifier because these codes are FDA Class III devices; absence of KF will result in claim rejection.

Automatic external defibrillators (non-wearable E0617, wearable K0606, and other types A9270) are covered under the Durable Medical Equipment benefit when the reasonable and necessary (R&N) requirements in the related Local Coverage Determination (LCD) and applicable statutory payment requirements are met.
Transesophageal echocardiography (TEE) is indicated when transthoracic echocardiography (TTE) provides inadequate visualization of cardiac anatomy for structures normally visualized by TTE; report ICD-10-CM R93.1 or R93.8 as the primary diagnosis and the cardiac abnormality as a secondary diagnosis.
TEE is indicated when performed during an open chest (intraoperative) procedure; report ICD-10-CM Z01.89 as the primary diagnosis and the reason for the surgical procedure as the secondary diagnosis.
Use CPT 93315, 93316, or 93317 for evaluation of congenital cardiac anomalies (these codes are reserved for congenital anomalies only).
CPT 93355 is indicated to report TEE services performed during transcatheter intracardiac therapies and includes probe passage, image acquisition/interpretation, intra-procedural manipulation to guide sizing/placement, assessment of adequacy and complications, and final report.
3D imaging (CPT 93319) and CT/MR fusion or related add-on imaging (CPT 76376, 76377) are allowable when billed as add-on services with their listed base TEE imaging codes.

A58761 — Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

J05

L39044 — MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

J05

A56781 — Billing and Coding: Transthoracic Echocardiography (TTE)

J06

L33577 — Transthoracic Echocardiography (TTE)

J06

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