Does E64.3 require prior authorization?

No, E64.3 does not require prior authorization (high confidence). Covered without prior authorization.

`E64.3`, Sequelae of rickets

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

When a referring or ordering physician is required, the referring/ordering provider's name and NPI must be reported on the claim.
For diagnostic tests, report the test result on the claim if known; if the result is not known at time of billing, report the symptoms that prompted the test.
Diagnosis code(s) on the claim must best describe the patient's condition for which the Vitamin D assay was performed.
All services and procedures performed on the same day for the same beneficiary by the same physician/provider should be billed on the same claim (use appropriate claim form and fields per CMS guidance).

Vitamin D assay testing is payable under Medicare Part B when performed in an office (POS 11), independent clinic (POS 49), Federally Qualified Health Center (POS 50), or independent laboratory (POS 81).
Non-physician practitioners (e.g., nurse practitioners, clinical nurse specialists, physician assistants) may certify, order, and establish the plan of care for Vitamin D assay testing as authorized by State law (outpatient settings other than CORFs).
Surgical repair of hammertoe deformity (including claw toe and mallet toe) in skeletally mature individuals (i.e., after epiphyseal closure) or individuals who are 18 years of age or older when ALL of the following are met: radiographic confirmation of hammer toe deformity; documentation of skeletal maturity; documentation of persistent pain and difficulty walking following at least 3 months of conservative treatment under the direction of a healthcare professional; and presence of one or more o [...]
Radiographic confirmation of hammer toe deformity (anterior/posterior and lateral views with interpretation and report).
Documented skeletal maturity (or age ≥ 18 years).
Persistent pain and difficulty walking following at least 3 months of conservative treatment under the direction of a healthcare professional.

WPS-J5-L34658, Vitamin D Assay Testing

A57484, Billing and Coding: Vitamin D Assay Testing

WPS-J8-L34658, Vitamin D Assay Testing

ANTHEM-MP-A050277, ANC.00009 Cosmetic and Reconstructive Services of the Trunk, Groin, and Extremities

AETNA-CPB-0636

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