Question:

Does code 78434 require pre-authorization?

Answer:

For those payers that require pre-authorization for nuclear medicine procedures, then yes, 78434 probably does need pre-authorization. The payer’s website should give you a list of codes needing pre-authorization, or if you’ve had a denial because there was no pre-authorization, then you will know in the future to pre-authorize. Medicare does not, at present, require preauthorization for this code. However, when the Appropriate Use Criteria (AUC) program goes fully live, 78434 is one of those codes that must have a Clinical Decision Support Mechanism (CDSM) consult.

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