Does N25.0 require prior authorization?

No, N25.0 does not require prior authorization (high confidence). Covered without prior authorization.

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`N25.0`, Renal osteodystrophy

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Medical records must document the medical necessity of the serum magnesium test, including the signs, symptoms, and/or diagnosis that prompted the test.
Laboratories must maintain the physician's order for the serum magnesium test in their records.
Medical records must contain the serum magnesium lab test results.
When requesting individual consideration through written redetermination, providers must include all relevant medical records and supporting literature.

Key Coverage Criteria

No biochemical markers of bone remodeling are identified in this Clinical Policy Bulletin as established/covered for evaluation of fracture risk; Aetna considers measurement of the listed bone turnover markers for evaluating fracture risk experimental and investigational.
Aetna considers measurement of the following specific bone turnover markers experimental and investigational for evaluating fracture risk (list not all-inclusive): Bone sialoprotein; Cathepsin K; Cobalamine (Vitamin B12); Dickkopf-related protein 1 (DKK-1); Hydroxyproline; Insulin-like growth factor-1 (IGF-1); Osteocalcin; Osteoprotegerin; Procollagen type I amino terminal propeptide (P1NP); Pyridinium crosslinks (pyridinoline, deoxypyridinoline); Receptor activator of nuclear factor kappa-B lig [...]
No biochemical markers (including serum or urinary collagen crosslinks or other BTMs) are established/covered for routine screening, diagnosis, or management of osteoporosis according to this CPB.
Aetna considers measurement of bone turnover markers experimental and investigational for diagnosis and monitoring of aseptic loosening and/or osteolysis related to wear or corrosion in total joint arthroplasty.
Aetna considers measurement of bone turnover markers experimental and investigational for persons receiving serotonergic antidepressants (i.e., NOT established/covered for evaluating bone effects in this population).
Aetna considers measurement of collagen crosslinks experimental and investigational for screening, diagnosis, or management of bisphosphonate-induced jaw osteonecrosis, chronic kidney disease, osteogenesis imperfecta, or other indications.

5 Active Policies

ANTHEM-CG-LAB-24, Outpatient Urine Culture

ANTHEM-CG-LAB-29, Gamma Glutamyl Transferase Testing

AMBETTER-CP.MP.152, Measurement of Serum 1,25-dihydroxyvitamin D

AETNA-CPB-0562, Biochemical Markers of Bone Remodeling

A57189, Billing and Coding: Serum Magnesium

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N25.0, Renal osteodystrophy