Does E78.89 require prior authorization?

No, E78.89 does not require prior authorization (high confidence). Covered without prior authorization.

`E78.89`, Other lipoprotein metabolism disorders

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.
Document the medical necessity for the chosen test frequency in the medical record (preferably on the test report).
Document that any applicable physician supervision requirement is met (preferably on the test report).

Stress testing (exercise or pharmacological, including stress echocardiography) is covered when the results will potentially affect the patient’s treatment plan.
An initial follow-up stress test may be indicated several months after myocardial infarction (MI), coronary artery bypass graft (CABG), or percutaneous transluminal coronary angioplasty (PTCA) when clinically appropriate.
A second follow-up stress test may be indicated approximately one year after the first follow-up test following MI, CABG, or PTCA when clinically appropriate.
Patients with silent coronary disease (no reliable signs or symptoms) may require stress testing as often as annually when clinically indicated.
Patients who present with reliable symptoms or signs of coronary artery disease (e.g., angina pectoris) may require stress testing as dictated by symptoms but typically will not require annual testing.
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.