Does Z13.220 require prior authorization?

No, Z13.220 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

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`Z13.220`, Encounter for screening for lipoid disorders

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Documentation Required

None specified in the policy (no documentation requirements listed because the devices are designated experimental/investigational and not covered).
No explicit separate 'Documentation Requirements' section is provided in the CPB. Inferred required documentation to support medical necessity includes:
Clinical documentation of hypertriglyceridemia (laboratory triglyceride value), particularly triglyceride >250 mg/dL (policy specifically references directly measured LDL-C indication at >250 mg/dL) or >400 mg/dL where calculated LDL is inaccurate

Medical necessity documentation for diagnostic cholesterol testing when screening is otherwise 'preventive' and the member’s plan does not cover preventive services (i.e., documentation why test is diagnostic/medically necessary)

Key Coverage Criteria

None — Aetna considers cholesterol monitors for home use (e.g., Cholestron cholesterol monitor, molecularly imprinted membrane modified gel colorimetric device) experimental and investigational and does not identify any covered indications in this policy.
For hypertriglyceridemia: CPT 83721 (Lipoprotein, direct measurement; LDL cholesterol) covered if selection criteria are met
ICD-10 E78.1 (Pure hyperglyceridemia) — covered if selection criteria are met
ICD-10 E78.2 (Mixed hyperlipidemia) — covered if selection criteria are met
ICD-10 Z13.220 (Encounter for screening for lipoid disorders) — covered if selection criteria are met
For hypertriglyceridemia the following ICD-10 codes covered if selection criteria are met: E08.00 - E13.9 (Diabetes mellitus), E78.1, E78.2

3 Active Policies

CIGNA-0398, Transvaginal Ultrasound, Non-Obstetrical

AETNA-CPB-0367, Home Cholesterol Monitors

AETNA-CPB-0525, Screening for Lipid Disorders

`Z13.220`, Encounter for screening for lipoid disorders

Prior Authorization

Documentation Required

Key Coverage Criteria

3 Active Policies

Related Codes

Have a follow-up question?

Z13.220, Encounter for screening for lipoid disorders

Prior Authorization

Documentation Required

Key Coverage Criteria

3 Active Policies

Related Codes

Have a follow-up question?

`Z13.220`, Encounter for screening for lipoid disorders