Does K05.5 require prior authorization?

No, K05.5 does not require prior authorization (high confidence). Covered without prior authorization.

`K05.5`, Other periodontal diseases

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Verify and document compliance with applicable NCCI edits and OPPS packaging rules prior to billing.
Include a valid ICD-10-CM diagnosis code on the claim that best describes the patient's condition for which the heavy metal test was performed.
For diagnostic heavy metal tests, report the test result on the claim if known; if the result is not known, report the symptoms that prompted the test.
When required, report the referring/ordering physician's name and NPI on the claim.

Serum thallium testing is covered for beneficiaries with documented industrial thallium exposure and unexplained ataxia.
Serum tin testing is covered for beneficiaries with documented industrial tin exposure.
Serum aluminum testing is covered for beneficiaries on chronic dialysis with evidence suggesting aluminum toxicity or for beneficiaries with documented chronic industrial aluminum exposure.
Serum and/or urine antimony testing is covered for beneficiaries with documented prior treatment with antileishmaniasis agents or with documented chronic industrial antimony exposure.
Serum, whole blood and/or urine arsenic testing is covered for beneficiaries with unexplained peripheral neuropathy, industrial arsenic exposure, history of arsenic pesticide exposure, unexplained encephalopathy, unexplained weight loss, chronic glomerulonephritis, bone marrow hypoplasia, melanosis of skin, unexplained chronic diarrhea, persistent abdominal pain, or nausea and vomiting.
Serum and/or urine barium testing is covered for beneficiaries with pulmonary disease and documented industrial barium exposure or for beneficiaries with unexplained flaccid paralysis.

NGS-J6-L35074, Heavy Metal Testing

A56767, Billing and Coding: Heavy Metal Testing

NGS-JK-L35074, Heavy Metal Testing

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