Z20.5 — Contact with and (suspected) exposure to viral hepatitis
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Billing and coding for immunizations must follow the coverage indications, limitations, and medical necessity criteria set forth in the associated Local Coverage Determination LCD L34596 (Immunizations).
- Medical records must document the indication(s) supporting use of IVIG for each claim.
- For indications where routine IVIG use is not indicated, the medical record must document prior interventions that were unsuccessful or reasons those interventions were not tolerated.
- Documentation must support objective clinical response to IVIG for continued coverage.
Key Coverage Criteria
- IVIG is covered only for indications specified as covered in the related Local Coverage Determination (LCD) and when medical necessity criteria in that LCD are met.
- When the patient has not been previously immunized for rabies, coverage includes RIG (half IM and half wound on day 0) plus HDCV on days 0, 3, 7, 14, and 28.
- Vaccinations are covered only when directly related to treatment of an injury or direct exposure to a disease/condition listed in this policy.
- Preventive immunizations are covered for pneumococcal, hepatitis B, and influenza vaccines.
- Tdap or Td vaccines are covered when given for an acute injury in a person who is incompletely immunized for tetanus.
- For tetanus-prone wounds, tetanus toxoid (booster) should be administered if the patient has not had a booster dose within the past 5 years.
6 Active Policies
A56900 — Billing and Coding: Immunizations
J05
A57554 — Billing and Coding: Immune Globulins
J05
L34596 — Immunizations
J05
L34771 — Immune Globulins
J05
A57802 — Billing and Coding: Hepatic (Liver) Function Panel
Related Codes
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