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ICD-10-CM E74.9, Disorder of carbohydrate metabolism, unspecified | No Prior Auth

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`E74.9`, Disorder of carbohydrate metabolism, unspecified

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Key Coverage Criteria

Glycated serum protein testing (for example, hemoglobin (HbA1c), albumin, or fructosamine) testing is consideredmedically necessaryfor any of the following indications (A-F):
The individual is between the ages of 35 and 71 and has overweight or obesity*;or
The individual is of any age and is from a population with disproportionately high prevalence of diabetes mellitus**;or
Hyperglycemia has been found on other testing;or
To test individuals who are pregnant and considered to be at high risk for type 2 diabetes mellitus;or
Prior testing at least 3 months previously showed results near diabetes mellitus diagnostic thresholds;or

2 Active Policies

ANTHEM-CG-LAB-25, Outpatient Glycated Hemoglobin and Protein Testing

ANTHEM-CG-LAB-30, Outpatient Laboratory-based Blood Glucose Testing

Related Codes

E13.9(2 policies)E66.01(2 policies)D13.7(2 policies)E08.00(2 policies)E16.A3(2 policies)E28.2(2 policies)C25.4(2 policies)E66.9(2 policies)

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