Z01.84 — Encounter for antibody response examination
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- A claim submitted without a valid ICD-10-CM diagnosis code will be returned as an incomplete claim under Section 1833(e) of the Social Security Act; diagnosis must best describe the patient's condition for which the service was performed.
- For services requiring a referring/ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.
- For diagnostic (non-screening) use of the test, report the test result if known; if result is not available, report the symptoms prompting the test.
- When billing CPT 87641 for screening purposes (statutorily non-covered), ICD-10-CM diagnosis codes may be reported but payment will still be denied.
Key Coverage Criteria
- MenB — Dosing schedule varies by vaccine brand; for persons who remain at increased risk for N. meningitidis serogroup B disease, a single dose booster is considered medically necessary 1 year after primary series completion, then every 2 to 3 years thereafter.
- MenB — Vaccination of adolescents and young adults aged 16 to 23 years with a 2-dose MenB series on the basis of shared clinical decision-making (preferred age 16–18 years). Booster doses are not recommended by ACIP unless the person becomes at increased risk.
- Meningococcal vaccine for hematopoietic cell transplant (HCT) recipients — HCT recipients of all ages who received vaccines prior to HCT should be revaccinated routinely after HCT, including meningococcal vaccines.
- Meningococcal vaccine for solid organ transplant recipients — vaccination recommended for transplant recipients (context: altered immunocompetence and transplant-related immunosuppression).
- Pregnancy/lactation: pregnant and lactating women should receive MenACWY vaccine if indicated; MenB vaccination during pregnancy should be deferred unless woman is at increased risk and benefits outweigh potential risks.
- Persons with altered immunocompetence (functional or anatomic asplenia, persistent complement deficiency, complement inhibitor use, HIV) are recommended to receive both MenACWY and MenB vaccines.
3 Active Policies
A52379 — Billing and Coding: CPT Code 87641 (Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, methicillin resistant, amplified probe technique)
J06
CIGNA-0398 — Transvaginal Ultrasound, Non-Obstetrical - (0398)
AETNA-CPB-0356 — Meningococcal Vaccines
Related Codes
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