Does Z92.89 require prior authorization?

No, Z92.89 does not require prior authorization (high confidence). Code is covered without prior authorization.

`Z92.89` — Personal history of other medical treatment

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medical record documentation must demonstrate that the patient cannot tolerate oral bisphosphonates or that oral bisphosphonates are medically contraindicated (including documentation of severe esophagitis when applicable).
If inability to tolerate oral ibandronate is claimed, include appropriate intolerance/interaction codes (T50.995A-T50.995S, Y63.8, Z91.89, or Z92.89) in the documentation and claims as applicable.
For hypercalcemia of malignancy (E83.52), document the clinical rationale for ibandronate use and the specific related malignancy in the patient record.
For osteoporosis as a transplant complication, include the related transplant complication code plus T50.995A-T50.995S or Z87.19 to justify intravenous therapy.

Intravenous ibandronate sodium is reasonable and necessary only for patients for whom bisphosphonate therapy (including oral ibandronate) is medically indicated and who cannot tolerate oral therapy or have a medical contraindication to oral bisphosphonates.
Use for osteoporosis (including senile or other osteoporosis) is covered when oral bisphosphonate therapy is indicated but cannot be used due to intolerance or contraindication.
Ibandronate sodium may be used for management of hypercalcemia of malignancy when the medical record documents the rationale for use and the related malignancy.
Ibandronate sodium may be used for osteoporosis that is a complication of transplant when the claim includes the related complication-of-transplant code and documentation of inability to tolerate oral bisphosphonates.
Diagnostic mammography, breast sonography (echography), breast MRI, and ductography are covered when a clear clinical indication for the test is documented in the medical record and in the referral/order.
A diagnostic mammogram performed after an initial screening mammogram (conversion from screening to diagnostic) is allowable when the screening abnormality prompting additional views is documented in the record.

A52421 — Billing and Coding: Ibandronate Sodium

J06

L33394 — Drugs and Biologicals, Coverage of, for Label and Off-Label Uses

J06

A56448 — Billing and Coding: Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography

L33950 — Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography

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