Does R71.8 require prior authorization?

No, R71.8 does not require prior authorization (high confidence). Covered without prior authorization.

`R71.8`, Other abnormality of red blood cells

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Verify and document compliance with applicable NCCI edits and OPPS packaging rules prior to billing.
Include a valid ICD-10-CM diagnosis code on the claim that best describes the patient's condition for which the heavy metal test was performed.
For diagnostic heavy metal tests, report the test result on the claim if known; if the result is not known, report the symptoms that prompted the test.
When required, report the referring/ordering physician's name and NPI on the claim.

Serum iron testing is consideredmedically necessaryfor any of the following indications:
Evaluation of suspected iron deficiency in individuals who meet any of the following criteria:Abnormal blood counts consistent with iron deficiency including, but not limited to, the following:Decreased mean corpuscular volume (MCV);orDecreased hemoglobin/hematocrit when the MCV is low or normal;orIncreased red cell distribution width (RDW) and low or normal MCV;orEvidence of acute or chronic blood loss including, but not limited to, the following:Gastrointestinal blood loss;orHematuria;orMenorr [...]
Abnormal blood counts consistent with iron deficiency including, but not limited to, the following:Decreased mean corpuscular volume (MCV);orDecreased hemoglobin/hematocrit when the MCV is low or normal;orIncreased red cell distribution width (RDW) and low or normal MCV;or
Decreased mean corpuscular volume (MCV);or
Decreased hemoglobin/hematocrit when the MCV is low or normal;or
Increased red cell distribution width (RDW) and low or normal MCV;or

NGS-J6-L35074, Heavy Metal Testing

A56767, Billing and Coding: Heavy Metal Testing

NGS-JK-L35074, Heavy Metal Testing

ANTHEM-CG-LAB-21, Serum Iron Testing

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