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ICD-10-CM O21.0, Mild hyperemesis gravidarum | No Prior Auth

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`O21.0`, Mild hyperemesis gravidarum

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

Acupuncture may be provided as treatment when coverage for acupuncture services is available in the applicable benefit plan document and ALL medical necessity factors and ALL treatment planning/outcomes listed in the policy are met.
Tension-type Headache
Migraine Headache with or without Aura
Musculoskeletal joint and soft tissue pain (e.g., hip, knee, spine) resulting in a functional deficit (e.g., inability to perform household chores, interference with job functions, loss of range of motion)
Nausea Associated with Pregnancy (only when co-managed)
Post-Surgical Nausea (only when co-managed)

3 Active Policies

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

CIGNA-CPG024, Acupuncture

A57189, Billing and Coding: Serum Magnesium

Related Codes

O09.291(2 policies)O10.011(2 policies)O09.13(2 policies)O09.211(2 policies)O09.33(2 policies)O09.511(2 policies)O09.03(2 policies)O10.111(2 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.

Initial evaluation must include an appropriate level of clinical history, examination, and medical decision-making relevant and appropriate to the individual's complaint(s) and presentation.