Does E78.9 require prior authorization?

No, E78.9 does not require prior authorization (high confidence). Covered without prior authorization.

`E78.9`, Disorder of lipoprotein metabolism, unspecified

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.
Article provides billing, coding, and guideline information that complements LCD L36139; claims must follow the LCD and MolDX program requirements (including appropriate CPT/HCPCS and ICD-10 coding and any LCD-required documentation or prior authorization).
Follow the Local Coverage Determination MolDX: Biomarkers in Cardiovascular Risk Assessment (L36523) for required documentation, medical necessity criteria, and claim submission instructions; this article provides supplemental billing and coding guidance only.

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.
None — Aetna considers cholesterol monitors for home use (e.g., Cholestron cholesterol monitor, molecularly imprinted membrane modified gel colorimetric device) experimental and investigational and does not identify any covered indications in this policy.
Thyroid function testing is consideredmedically necessaryfor individuals who meet any of the following indications:
For evaluation of signs or symptoms consistent with thyroid disease;or
To evaluate, assess, or monitor confirmed or suspected thyroid disease;or
To evaluate thyroid function when there are risk factors for thyroid disease.

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

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