Does R78.71 require prior authorization?

No, R78.71 does not require prior authorization (high confidence). Covered without prior authorization.

`R78.71`, Abnormal lead level in blood

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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 records must document the medical necessity of the serum magnesium test, including the signs, symptoms, and/or diagnosis that prompted the test.
Laboratories must maintain the physician's order for the serum magnesium test in their records.
Medical records must contain the serum magnesium lab test results.

No specific clinical indications are listed in this article; follow the Local Coverage Determination (LCD) L39400 for indications for magnesium testing or services.
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

ANTHEM-CG-LAB-21, Serum Iron Testing

ANTHEM-CG-MED-90, Chelation Therapy

ANTHEM-CG-LAB-30, Outpatient Laboratory-based Blood Glucose Testing

A56686, Billing and Coding: HbA1c

A57189, Billing and Coding: Serum Magnesium

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