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ICD-10-CM O21.9, Vomiting of pregnancy, unspecified | No Prior Auth

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`O21.9`, Vomiting of pregnancy, unspecified

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

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.
Subjective historical evaluation based on standardized methods such as the '10 questions'.
Specific standardized and non-standardized tests, assessments, and tools as appropriate.
Interpretation and synthesis of all relevant clinical findings derived from history and physical examination for clinical decision-making.

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)

2 Active Policies

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

CIGNA-CPG024, Acupuncture

Related Codes

O21.0(2 policies)76805(1 policies)76816(1 policies)76811(1 policies)76812(1 policies)76815(1 policies)76810(1 policies)76802(1 policies)

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Subjective and objective measurable description of functional status using comparable and consistent methods.

Summary of clinical reasoning and consideration of contextual factors with recommendations.