Does Z33.1 require prior authorization?

No, Z33.1 does not require prior authorization (high confidence). Code is covered without prior authorization.

Verity

`Z33.1` — Pregnant state, incidental

ICD-10-CM

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high 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.

20 Active Policies

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

J05

A57554 — Billing and Coding: Immune Globulins

J05

L34771 — Immune Globulins

J05

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

J05

Have a follow-up question?

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

In the narrative section of the claim form (Part A Loop 2300/NTE for EMC claims, or Form Locator 80 on the CMS 1450 form or paper claims, Part B Loop 2400/SV101-7 for EMC claims, or Item 19 on the CMS 1500 form for paper claims) please enter the following verbiage (without quotation marks) as it pertains to the respective tests.

For Claims submitted prior to 1/1/2018 use the following guidance: 1. Zika rRT-PCR only – Use CPT® 87999 and enter “Zika PCR” ... 2. Trioplex rRT-PCR – Use CPT® 87999 and enter “Zika Trioplex”.

— Serum and Urine Marker Screening for Fetal Aneuploidy

AETNA-CPB-0541 — Dialysis

AETNA-CPB-0553 — Lead Testing

AETNA-CPB-0643 — Diagnosis of Vaginitis

A55326 — Billing and Coding: Zika Virus Testing by PCR and ELISA Methods

AMBETTER-CP.MP.97 — Testing for Select Genitourinary Conditions

A58720 — Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

A58726 — Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

A58747 — Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

L38988 — MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

L39001 — MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

L39003 — MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

L39038 — MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

A58710 — Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

A55327 — Billing and Coding: Zika Virus Testing by PCR and ELISA Methods

AETNA-CPB-0088 — Antepartum Fetal Surveillance

Z33.1 — Pregnant state, incidental