Does E72.12 require prior authorization?

No, E72.12 does not require prior authorization (high confidence). Covered without prior authorization.

`E72.12`, Methylenetetrahydrofolate reductase deficiency

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

The submitted medical record must support the selected ICD-10-CM code(s), and the submitted CPT/HCPCS code must accurately describe the service performed.
The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
When billing CPT 84999 for the listed tests, include a note identifying the specific test in the Remarks (Part A) or Narrative (Part B) area of the claim.
All documentation must be maintained in the patient's medical record, be legible, include patient identification (e.g., complete name) and dates of service, and be made available to the contractor upon request.

For tests that currently lack specific CPT codes (functional intracellular analysis and total antioxidant function), bill using CPT 84999 and add a note identifying which test was performed in the Remarks area for Part A claims and the Narrative area for Part B claims.
Coverage and reasonable/necessary determinations for assays for vitamins and metabolic function are governed by LCD L34914 and claims must meet that LCD's requirements to be covered.
Macrocytic anemia
Documented cobalamin (vitamin B-12) deficiency (clinical and/or laboratory evidence such as low serum B-12 and/or elevated MMA/Hcy) requiring replacement therapy.
Pernicious anemia (decreased production or action of intrinsic factor) causing vitamin B-12 deficiency.
Post-gastrectomy vitamin B-12 deficiency (loss of intrinsic factor production).

NOVITAS-JH-L34914, Assays for Vitamins and Metabolic Function

NOVITAS-JL-L34914, Assays for Vitamins and Metabolic Function

A56416, Billing and Coding: Assays for Vitamins and Metabolic Function

AMBETTER-CG-Metab-Endo-Mito-DO-2025.1, Concert Genetic Testing: Metabolic, Endocrine, and Mitochondrial Disorders

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