Does E78.79 require prior authorization?

No, E78.79 does not require prior authorization (high confidence). Covered without prior authorization.

`E78.79`, Other disorders of bile acid and cholesterol metabolism

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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.
Billing, coding, and guideline information herein complement and must be used in conjunction with the Local Coverage Determination MolDX: Biomarkers in Cardiovascular Risk Assessment (LCD L36358); follow LCD L36358 for clinical criteria and claim adjudication.
An interpretation and report must be a complete, separately identifiable written report addressing findings, relevant clinical issues, comparative data (when available), and must be included in the medical record.
The patient's medical record must be legible and clearly document the reasonableness and necessity of the ECG and show that the service was necessary for at least one covered condition in the policy.

An ECG is covered when the result is relevant to the management, diagnosis, or treatment of the patient.
A separate ECG on the same day as a cardiac stress test is payable only when it provides additional clinically necessary information beyond the stress test (e.g., to rule out acute myocardial infarction prior to performing the stress test).
Rhythm ECGs are covered when used to evaluate signs or symptoms suggesting a cardiac rhythm disorder.
Home-based ECG services (including additional payment above the base ECG amount for transportation) are covered when there is a documented medical need to perform the ECG in the patient's home, typically for homebound or bed-confined patients.
A second professional component (PC) interpretation may be paid when a second physician’s substantially greater expertise is necessary and reasonable to clarify a questionable or confusing ECG finding and contributes substantially to diagnosis or treatment.
This article contains billing and coding guidance only and does not itself define clinical indications; refer to MolDX: Biomarkers in Cardiovascular Risk Assessment LCD L36139 for covered clinical indications.

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.