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ICD-10-CM R03.0, Elevated blood-pressure reading, without diagnosis of hypertension | No Prior Auth

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`R03.0`, Elevated blood-pressure reading, without diagnosis of hypertension

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.

Key Coverage Criteria

93280 dual lead pacemaker system
93281 multiple lead pacemaker system
Z99.2 Dependence on renal dialysis
Other CPT codes related to the CPB (listed as related items): 90935 - 90937 Hemodialysis
Aetna considers self-contained pacemaker monitors medically necessary for members with cardiac pacemakers.
Audible/visible signal pacemaker monitors -- these devices produce an audible and visible signal that indicates the pacemaker rate.

2 Active Policies

AETNA-CPB-0548, Cardiovascular Monitoring Equipment for Home Use: Pulse, Blood Pressure, Telemonitors, and Pacemaker Monitors

A57189, Billing and Coding: Serum Magnesium

Related Codes

N17.0(2 policies)93050(1 policies)D57.02(1 policies)C1833(1 policies)C2624(1 policies)D56.1(1 policies)93264(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.

For home blood pressure monitor coverage: 'the blood pressure cuff is prescribed by a physician.'