Does R70.1 require prior authorization?

No, R70.1 does not require prior authorization (high confidence). Code is covered without prior authorization.

`R70.1`, Abnormal plasma viscosity

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service).
The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
The submitted medical record must support the use of the selected ICD-10-CM code(s).

Esophagogastroduodenoscopy (EGD) is covered when it meets the reasonable and necessary requirements specified in Local Coverage Determination L33583.
Genetic testing for non-cancerous hematologic conditions to confirm a diagnosis in patients with signs and/or symptoms of a specific hematologic condition.
Genetic testing when confirmation of a hematologic diagnosis may alter patient management or eliminate the need for further diagnostic workup.
Genetic testing for Factor V (Leiden) and Prothrombin (F2) 20210G>A variants when evaluating inherited thrombophilia or personal/family history of venous thromboembolism.
Alpha- and beta-globin (HBA1/HBA2 and HBB) variant and dosage analysis for evaluation of suspected alpha thalassemia, beta thalassemia, sickle cell disease, or related hemoglobinopathies.
Factor VIII (F8) and Factor IX (F9) genetic analysis for diagnosis/evaluation of Hemophilia A and Hemophilia B.

FIRST_COAST-L33583, Diagnostic and Therapeutic Esophagogastroduodenoscopy

A57063, Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy

AMBETTER-CG-Hema-Cond-(nonCA)--2025.1, Concert Genetic Testing: Hematologic Conditions (non-cancerous)

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