Does O48.1 require prior authorization?

No, O48.1 does not require prior authorization (high confidence). Covered without prior authorization.

`O48.1`, Prolonged pregnancy

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Because of the rapid evolution of genetic testing, the decision to rescreen a patient should be undertaken only with the guidance of a genetics professional who can best assess the incremental benefit of repeat testing for additional mutations.
Carrier screening for a particular condition generally should be performed only once in a person's lifetime and the results should be documented in the patient's health record.
If an individual is found to be a carrier for a specific condition, the individual's reproductive partner should be offered testing in order to receive informed genetic counseling about potential reproductive outcomes.
Counseling before screening should include the possibility of results in the 'no-call' category (indeterminate or uninterpretable results).

Preconception or prenatal carrier testing for an individual who has the capacity and intention to reproduce is considered medically necessary when ANY of the following criteria is met:
There is an identified pathogenic or likely pathogenic variant in a blood relative
EITHER of the following criteria is met: an individual's reproductive partner is a known carrier of a disease-causing pathogenic or likely pathogenic variant in a recessively inherited condition
EITHER of the following criteria is met: a genetic diagnosis has been confirmed in an affected relative, AND the affected relative has not had genetic testing and is unavailable for testing
Preconception or prenatal genetic testing of a prospective parent whose sex assigned at birth is female for Fragile X (i.e., FMR1) pathogenic/likely pathogenic gene variants is considered medically necessary for EITHER of the following indications:
family history of unexplained intellectual disability or developmental delay, or autism in a blood relative

CIGNA-0514, Genetic Testing for Reproductive Carrier Screening and Prenatal Diagnosis

ANTHEM-CG-LAB-20, Thyroid Testing

ANTHEM-CG-LAB-30, Outpatient Laboratory-based Blood Glucose Testing

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

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