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ICD-10-CM O02.1, Missed abortion | No Prior Auth

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`O02.1`, Missed abortion

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

Pre-test genetic counseling is strongly recommended in order to inform persons being tested about the advantages and limitations of the test as applied to a unique person.
Chromosome microarray testing using array comparative genomic hybridization (aCGH) and/or single-nucleotide polymorphism (SNP) array is proven and medically necessary for the following:
Evaluation of an embryo/fetus in the following cases:
Intrauterine Fetal Demise or Stillbirth
Testing the products of conception following pregnancy loss
Individuals undergoing invasive prenatal testing (i.e., amniocentesis, chorionic villus sampling, or fetal tissue sampling)

2 Active Policies

UHC-POL-chromosome-microarray-testing, Chromosome Microarray Testing (Non-Oncology Conditions)

A57189, Billing and Coding: Serum Magnesium

Related Codes

0209U(1 policies)81228(1 policies)81229(1 policies)81349(1 policies)81479(1 policies)83735(1 policies)D56.1(1 policies)0156U(1 policies)

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For redetermination, providers must submit at minimum two (2) Phase II studies or one (1) Phase III study to support the request.

Medical Records Documentation Used for Reviews: Medical records documentation may be required to assess whether the member meets the clinical criteria for coverage but does not guarantee coverage of the service requested; refer to the guidelines titled Medical Records Documentation Used for Reviews.