Does E34.2 require prior authorization?

No, E34.2 does not require prior authorization (high confidence). Code is covered without prior authorization.

`E34.2`, Ectopic hormone secretion, not elsewhere classified

ICD-10-CM

No Prior Auth Required

Code is 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).
Bone mass measurement tests are covered when ordered by the treating physician or a qualified non-physician practitioner authorized by state law.
An initial bone mass measurement is covered (Medicare reimbursement for an initial bone mass measurement may be allowed only once, regardless of sites studied).
A DXA confirmatory test may be performed and covered as a baseline for future monitoring (exception to the 'one type only' rule).
CPT code 77082 (vertebral fracture assessment) is covered when medically necessary, with symptoms documented and when results are anticipated to be used in patient management.

CGS-J15-L36460, Bone Mass Measurement

J15

CGS-J18-L36460, Bone Mass Measurement

J18

FIRST_COAST-L34018, Parathormone (Parathyroid Hormone)

A57122, Billing and Coding: Parathormone (Parathyroid Hormone)

A57132

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