Does TRICARE require prior authorization for CPT C1721?

Status not confirmed in our dataset. Confirm against the current TRICARE clinical policy before submitting.

What documentation does TRICARE require for CPT C1721?

Documentation requirements vary by case. Standard items include clinical notes, imaging or test results, history of conservative treatment, and a clear statement of medical necessity.

What if TRICARE denies the PA for CPT C1721?

Appeal in writing within 60 days, citing the specific clinical policy criteria the case meets and attaching supporting documentation. Many denials are reversed on first-level appeal when the criteria language is mirrored.

Prior Authorization

TRICARE Prior Authorization for CPT C1721

Cardioverter-defibrillator, dual chamber (implantable) · Standard commercial plans

Status not confirmed

Source

Data pending source-document linkage. Verify against TRICARE's current clinical policy before submission.

Not medical advice. PA policies change frequently. Always confirm against the payer's current policy before submitting. d3rx pulls directly from publicly published policy PDFs and refreshes daily.

We don't have a source-backed prior-authorization verdict for CPT C1721 with TRICARE under Standard commercial plans yet — confirm directly with the payer. The 2026 Medicare reference rate for this code is below, and you can draft the request free in Ask D3.

2026 Medicare rate for CPT C1721

CPT C1721 is not priced under the 2026 Medicare Physician Fee Schedule — drugs/biologicals price under ASP and lab tests under the CLFS. See the CPT C1721 code page for pricing detail.

How to submit the PA

1Verify the requirement against the current clinical policy linked above.
2Gather patient history, prior conservative treatment, and clinical justification.
3Submit via the payer's provider portal or designated PA channel.
4Document the reference number and follow up within 5 business days if no determination is received.

FAQ

Does TRICARE require prior authorization for CPT C1721?: Status not confirmed in our dataset. Confirm against the current TRICARE clinical policy before submitting.
What documentation does TRICARE require for CPT C1721?: Documentation requirements vary by case. Standard items include clinical notes, imaging or test results, history of conservative treatment, and a clear statement of medical necessity.
What if TRICARE denies the PA for CPT C1721?: Appeal in writing within 60 days, citing the specific clinical policy criteria the case meets and attaching supporting documentation. Many denials are reversed on first-level appeal when the criteria language is mirrored.

Other TRICARE PA lookups

CPT J0897 CPT J1745 CPT G2211 CPT J3301 CPT J0585 CPT G0402 CPT G0439 CPT G0438

All TRICARE prior-authorization requirements →

CPT C1721 prior authorization by payer

Blue Cross Blue Shield Cigna Aetna Humana Medicare Anthem

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