Does R73.01 require prior authorization?

No, R73.01 does not require prior authorization (high confidence). Covered without prior authorization.

Backwork Sign up free

`R73.01`, Impaired fasting glucose

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

This article provides billing, coding and guideline information that complements Local Coverage Determination (LCD) L33431 for HbA1c; refer to LCD L33431 for clinical coverage criteria and specific documentation requirements.
Medical record must document the clinical suspicion or diagnosis of MASLD/MASH and cite adherence to relevant professional society guidelines for the diagnosis.
Medical record must include results of the primary non-molecular risk assessment (e.g., FIB-4 value) demonstrating non-low risk (example: FIB-4 >= 1.3).
Medical record must document that LSM (VCTE, MRE) is indeterminate or was not performed.

Key Coverage Criteria

Thyroid function testing is consideredmedically necessaryfor individuals who meet any of the following indications:
For evaluation of signs or symptoms consistent with thyroid disease;or
To evaluate, assess, or monitor confirmed or suspected thyroid disease;or
To evaluate thyroid function when there are risk factors for thyroid disease.
Glycated serum protein testing (for example, hemoglobin (HbA1c), albumin, or fructosamine) testing is consideredmedically necessaryfor any of the following indications (A-F):
The individual is between the ages of 35 and 71 and has overweight or obesity*;or

12 Active Policies

CGS-J15-L40199, MolDX: Biomarker Testing in Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis

J15

CGS-J15-L40198, MolDX: Biomarker Testing for Risk Stratification in Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis

J15

CGS-J18-L40198, MolDX: Biomarker Testing for Risk Stratification in Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis

J18

CGS-J18-L40199, MolDX: Biomarker Testing in Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis

J18

Have a follow-up question?

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

Ask Backwork about R73.01 Sign up free

R73.01, Impaired fasting glucose