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ICD-10-CM T57.0X3S, Toxic effect of arsenic and its compounds, assault, sequela | No Prior Auth

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`T57.0X3S`, Toxic effect of arsenic and its compounds, assault, sequela

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

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.

Key Coverage Criteria

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.

2 Active Policies

ANTHEM-CG-MED-90, Chelation Therapy

A56612, Billing and Coding: CT of the Head

Related Codes

T45.4X4S(2 policies)T56.0X4S(2 policies)T45.4X2S(2 policies)T45.4X3S(2 policies)T45.4X5S(2 policies)T56.0X1A(2 policies)T45.4X1S(2 policies)T56.1X1S(2 policies)

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