Z03.79 — Encounter for other suspected maternal and fetal conditions ruled out
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- Enter specific test verbiage in the claim narrative field: for pre-1/1/2018 Zika rRT-PCR enter 'Zika PCR'; for pre-1/1/2018 Trioplex enter 'Zika Trioplex'; for other tests enter test-appropriate verbiage, using Part A Loop 2300/NTE or Form Locator 80 (CMS 1450) or Part B Loop 2400/SV101-7 or Item 19 (CMS 1500) as applicable.
- Claims must include at least one of the specified ICD-10 diagnosis codes on the claim to support Zika-related test billing.
- Laboratories must have and make available their FDA Emergency Use Authorization (EUA) for the respective test upon Noridian request.
- PRNT confirmatory testing, if indicated, is performed by CDC or CDC-designated labs and the PRNT test result/process is not billed to Medicare (do not submit PRNT claims).
Key Coverage Criteria
- For dates of service on or after 1/1/2018, bill Zika rRT-PCR using CPT 87662 when testing is ordered and the claim includes at least one of the listed ICD-10 diagnosis codes and testing follows FDA and CDC guidelines.
- For dates of service prior to 1/1/2018, bill Zika rRT-PCR using CPT 87999 and enter 'Zika PCR' in the claim narrative field when testing is ordered and the claim includes at least one of the listed ICD-10 diagnosis codes.
- For dates of service on or after 1/1/2018, bill Zika virus IgM testing using CPT 86794 when testing is ordered and the claim includes at least one of the listed ICD-10 diagnosis codes.
- Bill Dengue rRT-PCR using CPT 87798 when Dengue testing is ordered and the claim includes at least one of the listed ICD-10 diagnosis codes.
- Bill Chikungunya rRT-PCR using CPT 87798 when Chikungunya testing is ordered and the claim includes at least one of the listed ICD-10 diagnosis codes.
- If both Dengue and Chikungunya rRT-PCR testing are performed on the same date of service, bill once using CPT 87801.
6 Active Policies
A55327 — Billing and Coding: Zika Virus Testing by PCR and ELISA Methods
AETNA-CPB-0464 — Serum and Urine Marker Screening for Fetal Aneuploidy
ANTHEM-RAD.00038 — RAD.00038 Use of 3-D, 4-D or 5-D Ultrasound in Maternity Care
ANTHEM-CG-LAB-27 — CG-LAB-27 Human Chorionic Gonadotropin Testing
ANTHEM-CG-LAB-26 — CG-LAB-26 Outpatient Alpha-Fetoprotein Testing
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