Does Z86.002 require prior authorization?

No, Z86.002 does not require prior authorization (high confidence). Code is covered without prior authorization.

`Z86.002` — Personal history of in-situ neoplasm of other and unspecified genital organs

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

This article provides billing/coding guidelines that complement Local Coverage Determination L34417 for CT of the head; consult LCD L34417 for specific coverage, coding, and documentation requirements.
Select and report the appropriate CPT code for the laboratory-developed test.
Enter 1 unit of service (UOS) for the claim.
For Part B electronic professional claims (837P), place the appropriate DEX Z-Code identifier adjacent to the CPT code in Loop 2400 or SV101-7; for Part B paper claims, place it in Box 19.

Lab-developed tests for inherited cancer syndromes in patients with cancer (per LCD L38966) are covered when billed with the required claim elements specified in this policy.
Coverage applies for lab-developed tests (LDTs) for inherited cancer syndromes in patients with cancer when billed in accordance with MolDX LCD L38972.
Lab-developed tests for inherited cancer syndromes in patients with cancer are billed per this guidance and the referenced LCD L38974.
Lab-developed tests for inherited cancer syndromes in patients with cancer as described in Local Coverage Determination (LCD) L39040 are the services addressed by this billing/coding guidance.
Cranial CT (with or without contrast) is covered when the patient has clinical evidence of an intracranial disorder or an established intracranial disorder/disease.
Contrast-enhanced CT is reasonable and necessary to assess cerebral perfusion, for example in suspected or known cerebrovascular accident (CVA).

A58756 — Billing and Coding: MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer

J05

L39040 — MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer

J05

ANTHEM-CG-LAB-32 — CG-LAB-32 Cancer Antigen 125 Testing

A56612 — Billing and Coding: CT of the Head

A58652 — Billing and Coding: MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer

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