2025 ICD-10-CM code Z02.6
Encounter for examination for insurance purposes.
The medical necessity for this code is determined by the insurance company requesting the examination.
The physician is responsible for performing the necessary examination and documenting the findings.
- 21. Factors Influencing Health Status and Contact with Health Services (Z00-Z99)
- Persons encountering health services for examinations (Z00-Z13)
In simple words: This code is used when you have a medical examination required by an insurance company.
This code is used for encounters with healthcare services for an examination specifically for insurance purposes.
Example 1: A patient is required to undergo a medical examination by their life insurance company before a policy is issued., A patient is required to undergo a medical examination by their health insurance company for a pre-existing condition review., A patient is required to undergo a medical examination by their disability insurance company to determine eligibility for benefits.
Documentation should include the reason for the examination (e.g., life insurance application, pre-existing condition review), the date of the examination, the findings of the examination, and any other relevant information.
** This code is exempt from the Present on Admission (POA) reporting requirement.
- Specialties:General practice, family medicine, internal medicine, and any specialty involved in conducting insurance examinations.
- Place of Service:Office, Independent Clinic, or other places where insurance examinations are conducted.