Does T56.894S require prior authorization?

No, T56.894S does not require prior authorization (high confidence). Covered without prior authorization.

`T56.894S`, Toxic effect of other metals, undetermined, sequela

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

This article provides billing/coding guidelines that complement Local Coverage Determination L34417 for CT of the head; consult LCD L34417 for specific coverage, coding, and documentation requirements.
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.

Chelation therapy is consideredmedically necessarytreatment for individuals with relevant clinical findings suggestive of heavy metal toxicity and a probable exposure history inanyof the following conditions when confirmed by laboratory testing*:
Individuals with disorders of iron metabolism (for example, primary or secondary hemochromatosis);or
Lead overload in cases of acute or long-term lead exposure;or
Individuals with disorders of copper metabolism (for example, Wilsonâs disease);or
Arsenic, mercury, iron, copper, or gold poisoning when long-term exposure and toxicity has been confirmed;or
Aluminum overload in individuals on chronic hemodialysis.

NGS-J6-L35074, Heavy Metal Testing

A56767, Billing and Coding: Heavy Metal Testing

NGS-JK-L35074, Heavy Metal Testing

ANTHEM-CG-MED-90, Chelation Therapy

A56612, Billing and Coding: CT of the Head

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