Does Z91.0111 require prior authorization?

No, Z91.0111 does not require prior authorization (high confidence). Code is covered without prior authorization.

`Z91.0111` — Allergy to milk products with tolerance to baked milk

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

All documentation must be maintained in the patient's medical record and made available to the contractor upon request; every page must be legible and include appropriate patient identification (e.g., complete name, dates of service).
The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
The medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
Prior to testing there must be evidence that a history was obtained indicating possible allergy and that attempts were made to narrow the area of investigation so that the minimal necessary skin tests were selected.

Allergy testing is covered when the medical record documents a history indicating the possible presence of allergy and the clinician selected a minimal number of tests/antigens based on patient-specific history and physician examination.
Allergy testing is covered when the medical record documents the test(s) used, the interpretation(s), and objective measurement of reaction size (wheal and erythema in mm) or a standardized in vivo grading system.
CPT code 86003 (RAST type test) is covered when billed for diagnostic testing, subject to the stated annual frequency limit.
Allergy testing for inhalant allergens is covered when medically necessary; evaluation may include up to 90 prick-puncture tests followed by up to 40 intracutaneous tests if prick/puncture results are negative.
Allergy testing for food sensitivity is covered when medically necessary and may require up to 40 percutaneous tests.
Multitest intracutaneous testing of up to 60 tests may be appropriate in lieu of prick-puncture testing for selected patients (for example, young children, older adults, or needle-phobic individuals).

A57473 — Billing and Coding: Allergy Testing

J05

L36402 — Allergy Testing

J05

A57531 — Billing and Coding: Allergy Testing

J09

L33261 — Allergy Testing

J09

L36241 — Allergy Testing

J12

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