Does E78.41 require prior authorization?

No, E78.41 does not require prior authorization (high confidence). Covered without prior authorization.

`E78.41`, Elevated Lipoprotein(a)

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Medical record must document suspected B12 or folate deficiency or the specific ICD-10-CM code from LCD L34419 supporting risk stratification medical necessity.
For repeat testing, medical records must document prior appropriate treatment and objective evidence that the treatment did not correct the anemia or symptoms.
Claims should reference the applicable ICD-10-CM diagnosis code(s) that support medical necessity per LCD L34419.
Claims should be supported with documentation consistent with LCD L36129; this article provides billing and coding guidelines that complement that LCD and should be used alongside the LCD when submitting claims.

Serum homocysteine testing is covered for evaluation of suspected vitamin B12 (cobalamin) deficiency.
Serum homocysteine testing is covered for risk stratification for the conditions listed in the ICD-10-CM Codes that Support Medical Necessity in LCD L34419.
Serum homocysteine testing is covered for evaluation of suspected folate (vitamin B9) deficiency.
For covered laparoscopic restrictive procedures that require port replacement, bill CPT code 43771, 43772, or 43773.
Follow the LCD L33411 reasonable and necessary requirements for surgical management of morbid obesity when determining coverage.
An ECG is covered when the result is relevant to the management, diagnosis, or treatment of the patient.

CGS-J15-L36139, MolDX: Biomarkers in Cardiovascular Risk Assessment

J15

CGS-J18-L36139, MolDX: Biomarkers in Cardiovascular Risk Assessment

J18

A57559, Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment

WPS-J5-L36523, MolDX: Biomarkers in Cardiovascular Risk Assessment

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