Does O9A.113 require prior authorization?

No, O9A.113 does not require prior authorization (high confidence). Covered without prior authorization.

`O9A.113`, Malignant neoplasm complicating pregnancy, third trimester

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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.

NGS covers leuprolide acetate (LHRH analog) as palliative treatment of advanced breast carcinoma in premenopausal and perimenopausal women.
A drug use is covered if it is an FDA-approved labeled indication or is a medically accepted off-label indication supported by one of the accepted compendia at the specified levels (AHFS-DI supportive; NCCN Category 1 or 2A; Micromedex DrugDex Class I/IIa/IIb or Clinical Pharmacology supportive; Lexi-Drugs Evidence Level A) or by articles or LCDs published by National Government Services (NGS).
Off-label uses in anti-cancer chemotherapeutic regimens are covered when they meet the Medicare definition of a medically accepted indication per the Medicare Benefit Policy Manual (Pub 100-02, Ch.15, §50.4.5).
Medicare pays for an FDA-approved injectable drug when it was injected on or after the FDA approval date, is reasonable and necessary for the individual patient, and all other coverage requirements are met.
NGS covers denosumab (Prolia, Xgeva) for its FDA-approved and approved compendia uses.
NGS covers intra-articular hyaluronans for their FDA-approved and approved compendia uses.

NGS-J6-L33394, Drugs and Biologicals, Coverage of, for Label and Off-Label Uses

NGS-JK-L33394, Drugs and Biologicals, Coverage of, for Label and Off-Label Uses

A57189, Billing and Coding: Serum Magnesium

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