Does P91.829 require prior authorization?

No, P91.829 does not require prior authorization (high confidence). Covered without prior authorization.

`P91.829`, Neonatal cerebral infarction, unspecified side

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Clinical documentation that the test is being ordered for one of the medically necessary indications specified by policy (e.g., borderline vitamin B12 deficiency where results will impact management; idiopathic or recurrent VTE; CRVO meeting the stated criteria; evaluation for homocystinuria due to CBS deficiency).
For assessment of borderline vitamin B12 deficiency: documentation that results will impact the member's management (reference to CPB 0536 - Vitamin B-12 Therapy).
For central retinal vein occlusion (CRVO): documentation of age (<56 years), absence of strong arteriosclerotic risk factors, and/or personal history of previous thrombosis or family history of thrombosis when ordering homocysteine testing for CRVO evaluation.
For newborn screening of homocystinuria: documentation confirming hyper-methioninemia (homocysteine measurement only performed when hyper-methioninemia has been confirmed).

Assessment of idiopathic venous thrombo-embolism, recurrent venous thrombo-embolism, thrombosis occurring at a young age (i.e., less than 45 years of age), or thrombosis at an unusual site.
CPT code 83090 (Homocysteine) — covered if selection criteria are met.
ICD-10: D51.0 - D51.9 (Vitamin B12 deficiency anemia) — covered when selection criteria are met.
ICD-10: D81.818 (Other biotin-dependent carboxylase deficiency) — covered when selection criteria are met.
ICD-10: D81.819 (Biotin-dependent carboxylase deficiency, unspecified) — covered when selection criteria are met.
ICD-10: E53.8 (Deficiency of other specified B group vitamins) — covered when selection criteria are met.

AETNA-CPB-0763, Homocysteine Testing

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