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ICD-10-CM O26.42, Herpes gestationis, second trimester | No Prior Auth

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`O26.42`, Herpes gestationis, second trimester

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.

1 Active Policy

A57189, Billing and Coding: Serum Magnesium

Related Codes

D56.1(1 policies)D57.02(1 policies)D57.1(1 policies)D57.212(1 policies)D57.412(1 policies)D57.812(1 policies)D68.8(1 policies)83735(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.