Does I82.469 require prior authorization?

No, I82.469 does not require prior authorization (high confidence). Covered without prior authorization.

`I82.469`, Acute embolism and thrombosis of unspecified calf muscular vein

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.
The ordering/referring practitioner's assessment related to the patient's complaint and the specific reason for the test must be documented in the medical record.

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.
Non-invasive vascular diagnostic tests are covered when ordered by the treating practitioner or a consulting physician who will use the results to manage the beneficiary's specific medical problem.
A documented referral/order must be on record for each individual non-invasive vascular study performed for coverage to apply.
Cerebrovascular arterial duplex follow-up is covered annually for stenosis 20–49% (diameter reduction).

CGS-J15-L34045, Non-Invasive Vascular Studies

J15

CGS-J15-L40258, MolDX: Genetic Testing for Hereditary Thrombophilia

J15

CGS-J18-L40258, MolDX: Genetic Testing for Hereditary Thrombophilia

J18

CGS-J18-L34045, Non-Invasive Vascular Studies

J18

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