Does Z45.018 require prior authorization?

No, Z45.018 does not require prior authorization (high confidence). Code is covered without prior authorization.

`Z45.018` — Encounter for adjustment and management of other part of cardiac pacemaker

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

For services requiring a referring/ordering physician, the referring/ordering provider's name and NPI must be reported on the claim.
The patient's medical record must document assessment related to the visit complaint, relevant medical history, results of pertinent tests/procedures, and signed and dated office visit or operative reports for all services ordered or rendered.
Claims must be submitted with ICD-10-CM codes that reflect the patient's condition and reason for the service; claims without ICD-10-CM codes will be returned.
The study requires a formal written interpretive report including clear identifying demographics, the interpreting provider's name, reason for the test, an interpretive report, copies of images, and maintenance of computerized image reconstruction data.

CCT/CCTA is covered when the patient's medical record documents medical necessity consistent with Local Coverage Determination L33947 and the claim is submitted with an appropriate ICD-10-CM diagnosis code reflecting the reason for testing.
When billing Medicare Part B for analysis of a Wearable Defibrillator System, report CPT code 93292.
Report CPT codes 93260, 93261, and 93279-93292 when performing the corresponding cardiac rhythm device evaluation procedures (reported per procedure).
Cardiac CT (CCT) or Coronary CT Angiography (CCTA) is covered when the patient's medical record documents medical necessity consistent with the indications and limitations set forth in the attached Local Coverage Determination (LCD).
Interrogation (in-person, remote/web-based, or device transmission) of implantable or wearable cardioverter defibrillators (ICDs) is covered when medically necessary and supported by documentation of the ordering provider's assessment, relevant history, and pertinent test results.
In-person interrogation is covered for evaluation of clinical symptoms or device issues and may be performed as clinically appropriate based on symptomatology.

A56737 — Billing and Coding: Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA)

J06

L33559 — Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA)

J06

L34833 — Cardiac Rhythm Device Evaluation

J12

A56602 — Billing and Coding: Cardiac Rhythm Device Evaluation

J12

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