Does Z13.39 require prior authorization?

No, Z13.39 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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`Z13.39`, Encounter for screening examination for other mental health and behavioral 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

For MindX tests: "A qualified laboratory professional compiles the report that is communicated to the ordering provider detailing risk and medication suggestions."
"Requested by a psychiatrist as an aid to differentiate psychotic depression from schizophrenia."
For chemical hair analysis to be covered: documentation of clinical indication consistent with suspected chronic arsenic poisoning (for example, relevant signs/symptoms and/or use of covered ICD-10 codes such as T57.0X1A - T57.0X4S or Z13.88) and that selection criteria are met (policy states 'CPT codes covered if selection criteria are met').

For microscopic evaluation of hair structure (CPT 96902) to be covered: documentation that the test is being performed 'as part of the work-up of members with alopecia or abnormal-appearing or abnormally growing hair' and use of appropriate covered ICD-10 codes (L65.0 - L65.9; L67.0; L67.8 - L67.9; L73.1; L73.8 - L73.9).

Claims/testing should use the covered CPT/ICD-10 codes listed in the policy (e.g., CPT 82175, 83015 for chemical hair analysis when selection criteria are met; CPT 96902 for trichogram) and must not bill HCPCS P2031 for indications covered in this CPB (P2031 is listed as not covered).

Key Coverage Criteria

Dexamethasone suppression test (DST) — "medically necessary when it is requested by a psychiatrist as an aid to differentiate psychotic depression from schizophrenia."
ICD-10 codes covered if selection criteria are met for chemical hair analysis (arsenic): T37.8X1A - T37.96XS; T57.0X1A - T57.0X4S; Z13.88 (Encounter for screening for disorder due to exposure contaminants [suspected chronic arsenic poisoning]).
ICD-10 codes covered if selection criteria are met for microscopic hair evaluation (trichogram): L65.0 - L65.9; L67.0, L67.8 - L67.9; L73.1, L73.8 - L73.9.
Chemical hair analysis for diagnosis of suspected chronic arsenic poisoning (see covered ICD-10 codes such as T57.0X1A - T57.0X4S and Z13.88).
Microscopic evaluation of hair structure (trichogram) as part of the work-up of members with alopecia or abnormal-appearing or abnormally growing hair.
CPT codes covered if selection criteria are met: 82175 (Arsenic) and 83015 (Heavy metal; qualitative, any number of analytes) — when used for covered indications (see above).

3 Active Policies

CIGNA-0398, Transvaginal Ultrasound, Non-Obstetrical

AETNA-CPB-0300, Hair Analysis

AETNA-CPB-0306, Laboratory Tests for Depression and Other Psychiatric Disorders

`Z13.39`, Encounter for screening examination for other mental health and behavioral disorders

Prior Authorization

Documentation Required

Key Coverage Criteria

3 Active Policies

Related Codes

Have a follow-up question?

Z13.39, Encounter for screening examination for other mental health and behavioral disorders

Prior Authorization

Documentation Required

Key Coverage Criteria

3 Active Policies

Related Codes

Have a follow-up question?

`Z13.39`, Encounter for screening examination for other mental health and behavioral disorders