Does E20.1 require prior authorization?

No, E20.1 does not require prior authorization (high confidence). Covered without prior authorization.

`E20.1`, Pseudohypoparathyroidism

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Maintain all documentation in the patient's medical record and make it available to the contractor upon request; every page must be legible and include patient identification and dates of service.
The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing the patient's care.
The submitted medical record must support the use of the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must describe the service performed.
If the service provider is not the ordering/referring physician, that provider must maintain hard-copy documentation of test results and interpretation plus copies of the ordering/referring physician’s order.

Parathormone (parathyroid hormone) testing is covered when medical necessity and reasonable-and-necessary criteria specified in Local Coverage Determination L34018 are met.
For renal dialysis facilities submitting claims for parathormone testing, use diagnosis code N18.6 (end stage renal disease).
An ECG is covered when the result is relevant to the management, diagnosis, or treatment of the patient.
A separate ECG on the same day as a cardiac stress test is payable only when it provides additional clinically necessary information beyond the stress test (e.g., to rule out acute myocardial infarction prior to performing the stress test).
Rhythm ECGs are covered when used to evaluate signs or symptoms suggesting a cardiac rhythm disorder.
Home-based ECG services (including additional payment above the base ECG amount for transportation) are covered when there is a documented medical need to perform the ECG in the patient's home, typically for homebound or bed-confined patients.

FIRST_COAST-L34018, Parathormone (Parathyroid Hormone)

A57122, Billing and Coding: Parathormone (Parathyroid Hormone)

A57189, Billing and Coding: Serum Magnesium

A57326, Billing and Coding: Electrocardiograms

A59186, Billing and Coding: Magnesium

Ask Backwork about documentation requirements, denial risks, or coverage in your state.