Does R79.9 require prior authorization?

No, R79.9 does not require prior authorization (high confidence). Covered without prior authorization.

`R79.9`, Abnormal finding of blood chemistry, unspecified

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.
The article provides billing/coding guidance that complements LCD L39400; use the documentation, prior authorization, and claim submission requirements specified in LCD L39400 and the local contractor's instructions.
Claim must be accompanied by an appropriate ICD-10-CM diagnosis code(s) that supports medical necessity (see codes listed in the policy table).
Clinical documentation demonstrating that test results will inform medication selection or dosing (e.g., relevant medication history, reason for testing) — specific required documents not listed in excerpt.

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-LAB-25, Outpatient Glycated Hemoglobin and Protein Testing

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

AMBETTER-CG-Pharmacogenetics-2025.1-Version-B, Concert Genetic Testing: Pharmacogenetics (Version B)

A56686, Billing and Coding: HbA1c

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