Does N92.2 require prior authorization?

No, N92.2 does not require prior authorization (high confidence). Code is covered without prior authorization.

`N92.2`, Excessive menstruation at puberty

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Clinical documentation describing the bleeding manifestation(s) (type, severity, timing, relation to trauma or procedures).
Clinical documentation demonstrating the member has clinical features of hemophilia to support genetic testing (per policy criteria).
Provide hematologic screening results (examples: MCV, MCH, CBC, hemoglobin electrophoresis, dichlorophenol indophenol (DCIP)) showing either positive findings for a hemoglobinopathy or inconclusive results that do not rule out a hemoglobinopathy.
Laboratory results showing platelet count (normal), aPTT (prolonged) and PT (normal) with dates and values.

Genetic testing for non-cancerous hematologic conditions to confirm a diagnosis in patients with signs and/or symptoms of a specific hematologic condition.
Genetic testing when confirmation of a hematologic diagnosis may alter patient management or eliminate the need for further diagnostic workup.
Genetic testing for Factor V (Leiden) and Prothrombin (F2) 20210G>A variants when evaluating inherited thrombophilia or personal/family history of venous thromboembolism.
Alpha- and beta-globin (HBA1/HBA2 and HBB) variant and dosage analysis for evaluation of suspected alpha thalassemia, beta thalassemia, sickle cell disease, or related hemoglobinopathies.
Factor VIII (F8) and Factor IX (F9) genetic analysis for diagnosis/evaluation of Hemophilia A and Hemophilia B.
G6PD gene variant analysis (targeted testing or full gene sequencing/deletion-duplication) for evaluation of suspected glucose-6-phosphate dehydrogenase deficiency.

AMBETTER-CG-Hema-Cond-(nonCA)--2025.1, Concert Genetic Testing: Hematologic Conditions (non-cancerous)

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