Does R62.52 require prior authorization?

No, R62.52 does not require prior authorization (high confidence). Covered without prior authorization.

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`R62.52`, Short stature (child)

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Documentation that the member's clinical presentation is not specific to a well-delineated genetic syndrome when applicable.
For children with congenital anomalies: documentation of the malformation criteria (two or more major malformations; or a single major malformation or multiple minor malformations in an infant/child born with IUGR or small for gestational age; or a single major malformation and multiple minor malformations).
For DD/ID or ASD: documentation that targeted genetic testing (e.g., FMR1 for Fragile X) was performed and is negative when indicated by clinical/family history.
Documentation of evaluation and recommendation that CGH is warranted by a Board-Certified or Board-Eligible Medical Geneticist, Developmental/Behavioral Pediatrician, Pediatric or Adult Neurologist.

Key Coverage Criteria

Diagnosing genetic abnormalities in children with congenital anomalies when ALL of the following criteria are met: the member's clinical presentation is not specific to a well-delineated genetic syndrome; and the child has one or more of the following (see Appendix): two or more major malformations; or a single major malformation or multiple minor malformations in an infant or child that was born with intrauterine growth restriction (IUGR) or was small for gestational age; or a single major malf [...]
Diagnosing genetic abnormalities in children with intellectual disability (DD/ID) or autism spectrum disorder (ASD) (per DSM-5) when ALL of the following criteria are met: targeted genetic testing (for example: FMR1 gene analysis for Fragile X), if/when indicated by clinical and family history, is negative; the member's clinical presentation is not specific to a well-delineated genetic syndrome; the member has been evaluated by a Board-Certified or Board-Eligible Medical Geneticist, Developmenta [...]
Evaluating fetuses with structural abnormalities detected on fetal ultrasound or fetal magnetic resonance imaging.
Evaluating histologically equivocal Spitzoid melanocytic neoplasms (Spitz nevus and atypical Spitz tumors).
For pregnant women undergoing invasive prenatal diagnostic testing (amniocentesis or chorionic villus sampling) for any indication.
Analyses of fetal tissue (i.e., amniotic fluid, placenta, or products of conception) in the evaluation of intrauterine fetal death or stillbirth (which is 20 weeks gestation and greater).

3 Active Policies

AMBETTER-CG-Multi-Inher-DO.-Intel-Dis.-DD-2025.1, Concert Genetic Testing: Multisystem Inherited Disorders, Intellectual Disability, and Developmental Delay

AETNA-CPB-0220, Distraction Osteosynthesis

AETNA-CPB-0787, Comparative Genomic Hybridization (CGH)

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R62.52, Short stature (child)