Does R73.02 require prior authorization?

No, R73.02 does not require prior authorization (high confidence). Covered without prior authorization.

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`R73.02`, Impaired glucose tolerance (oral)

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

Patient is an adult (age >= 18) with clinical suspicion or diagnosis of metabolic dysfunction-associated steatotic liver disease (MASLD) or metabolic dysfunction-associated steatohepatitis (MASH) based on current professional society guidelines (e.g., AASLD, AGA, AACE).
Primary non-molecular/proteomic risk assessment per consensus guidelines does not indicate low risk (example threshold: fibrosis-4 index (FIB-4) >= 1.3).
Liver stiffness measurement (LSM) by imaging (e.g., VCTE, MRE) is indeterminate or LSM was not performed.
Results of the molecular or proteomic biomarker test will be used to directly inform pending management decisions (e.g., specialist referral, performance of liver biopsy, eligibility for pharmacologic therapy) as documented in the medical record.
Clinical validity of the test analytes/profiles for the intended use and population must be established in peer-reviewed literature with demonstrated reproducibility across clinical cohorts; if algorithm-based, the algorithm must be validated in a cohort independent of the development cohort.
The test must have satisfactorily completed a Molecular Diagnostic Services Program (MolDX) Technical Assessment (TA).

9 Active Policies

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

J15

CGS-J15-L40199, MolDX: Biomarker Testing 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

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R73.02, Impaired glucose tolerance (oral)