check_prior_auth
Determine Medicare prior authorization requirements for medical procedures by checking CPT/HCPCS codes against coverage policies and providing documentation checklists.
Instructions
Check if procedures require prior authorization for Medicare. Returns PA requirement, confidence level, matched LCD/NCD policies, and documentation checklist. Essential for determining Medicare coverage requirements before procedures.
Examples:
check_prior_auth(["76942"]) - check PA for ultrasound guidance
check_prior_auth(["76942"], { state: "TX" }) - check for Texas patient (determines MAC jurisdiction)
check_prior_auth(["J0585", "64493"]) - check multiple procedure codes
Input Schema
| Name | Required | Description | Default |
|---|---|---|---|
| procedure_codes | Yes | CPT/HCPCS codes to check (1-10 codes) | |
| state | No | Two-letter state code to determine MAC jurisdiction (e.g., TX, CA) |