Does O99.891 require prior authorization?

No, O99.891 does not require prior authorization (high confidence). Covered without prior authorization.

`O99.891`, Other specified diseases and conditions complicating pregnancy

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

This article provides billing, coding and guideline information that complements Local Coverage Determination (LCD) L33431 for HbA1c; refer to LCD L33431 for clinical coverage criteria and specific documentation requirements.

Serum iron testing is consideredmedically necessaryfor any of the following indications:
Evaluation of suspected iron deficiency in individuals who meet any of the following criteria:Abnormal blood counts consistent with iron deficiency including, but not limited to, the following:Decreased mean corpuscular volume (MCV);orDecreased hemoglobin/hematocrit when the MCV is low or normal;orIncreased red cell distribution width (RDW) and low or normal MCV;orEvidence of acute or chronic blood loss including, but not limited to, the following:Gastrointestinal blood loss;orHematuria;orMenorr [...]
Abnormal blood counts consistent with iron deficiency including, but not limited to, the following:Decreased mean corpuscular volume (MCV);orDecreased hemoglobin/hematocrit when the MCV is low or normal;orIncreased red cell distribution width (RDW) and low or normal MCV;or
Decreased mean corpuscular volume (MCV);or
Decreased hemoglobin/hematocrit when the MCV is low or normal;or
Increased red cell distribution width (RDW) and low or normal MCV;or

ANTHEM-CG-LAB-21, Serum Iron Testing

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

A56686, Billing and Coding: HbA1c

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