Does O11.1 require prior authorization?

No, O11.1 does not require prior authorization (high confidence). Covered without prior authorization.

`O11.1`, Pre-existing hypertension with pre-eclampsia, first trimester

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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.

An ECG is covered when the result is relevant to the management, diagnosis, or treatment of the patient.
A separate ECG on the same day as a cardiac stress test is payable only when it provides additional clinically necessary information beyond the stress test (e.g., to rule out acute myocardial infarction prior to performing the stress test).
Rhythm ECGs are covered when used to evaluate signs or symptoms suggesting a cardiac rhythm disorder.
Home-based ECG services (including additional payment above the base ECG amount for transportation) are covered when there is a documented medical need to perform the ECG in the patient's home, typically for homebound or bed-confined patients.
A second professional component (PC) interpretation may be paid when a second physician’s substantially greater expertise is necessary and reasonable to clarify a questionable or confusing ECG finding and contributes substantially to diagnosis or treatment.
Evaluation of germ cell tumors;or

ANTHEM-CG-LAB-27, Human Chorionic Gonadotropin Testing

ANTHEM-CG-RAD-26, Maternity Ultrasound in the Outpatient Setting

A57189, Billing and Coding: Serum Magnesium

A57326, Billing and Coding: Electrocardiograms

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