Does Z94.82 require prior authorization?

No, Z94.82 does not require prior authorization (high confidence). Code is covered without prior authorization.

`Z94.82` — Intestine transplant status

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medical documentation must show the transplant met Medicare coverage criteria in effect at the time, including facility approval status and applicable national/local medical necessity determinations.
Beneficiary enrollment must be documented: Medicare Part A enrollment at time of transplant and Medicare Part B enrollment at time of drug dispensing.
For pancreas-transplant-alone candidates, documentation must include type 1 diabetes diagnosis, beta-cell autoantibody status or fasting C‑peptide with a concurrently obtained fasting glucose, history of labile insulin-dependent diabetes with documented recurrent severe metabolic complications requiring hospitalization, and 12 months of endocrinologist-managed intensive care with advanced insulin therapies.
For pancreatic islet cell or partial pancreatic tissue transplants, documentation must demonstrate the procedure was part of an NIH-sponsored clinical trial to qualify for Medicare-covered routine costs including immunosuppressive drugs.

Immunosuppressive drugs are covered when prescribed following a covered organ transplant of kidney, heart, liver, bone marrow/stem cell, lung, or combined heart-lung.
Immunosuppressive drugs are covered after a whole-organ pancreas transplant that was performed concurrent with or subsequent to a kidney transplant for diabetic nephropathy when the transplant was performed on or after 1999-07-01.
Immunosuppressive drugs are covered after an intestinal transplant performed on or after 2001-04-01.
Immunosuppressive drugs are covered after pancreatic islet cell transplantation or partial pancreatic tissue transplantation performed on or after 2004-10-01 only when the procedure is conducted as part of an NIH-sponsored clinical trial (Medicare covers routine costs including immunosuppressive drugs).
Immunosuppressive drugs are covered after a pancreas transplant alone performed on or after 2006-04-26 if the transplant facility is Medicare-approved for kidney transplantation.
For pancreas-transplant-alone recipients, immunosuppressive drugs are covered only if beneficiary has type 1 diabetes and is beta cell autoantibody positive.

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