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Authorization is required when: Test is not preceded by basic diagnostics Symptoms are non-specific Frequency exceeds payer thresholds Required Documentation for Approval Authorization depends on structured clinical evidence: Clinical notes describing chest pain characteristics Prior test results (ECG, stress test, echocardiogram) Documented failure or limitation of initial testing Risk factors (age, diabetes, hypertension, CAD history) Operational Gap: Missing prior test documentation is one of the most common reasons for pre-authorization denial