Does Z13.820 require prior authorization?

No, Z13.820 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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`Z13.820`, Encounter for screening for osteoporosis

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

Implicit: because the CPB deems the listed uses experimental/investigational, documentation showing medical necessity for non‑experimental, evidence‑based indications is not described or endorsed.
No specific documentation requirements, test result thresholds, or required clinical record elements are specified in this policy bulletin for covered use. (Policy treats the listed measurements as experimental/investigational and not covered.)
Laboratory tests are not covered unless they are ordered by a physician or other qualified health professional. Please check benefit plan descriptions.

Key Coverage Criteria

No biochemical markers of bone remodeling are identified in this Clinical Policy Bulletin as established/covered for evaluation of fracture risk; Aetna considers measurement of the listed bone turnover markers for evaluating fracture risk experimental and investigational.
Aetna considers measurement of the following specific bone turnover markers experimental and investigational for evaluating fracture risk (list not all-inclusive): Bone sialoprotein; Cathepsin K; Cobalamine (Vitamin B12); Dickkopf-related protein 1 (DKK-1); Hydroxyproline; Insulin-like growth factor-1 (IGF-1); Osteocalcin; Osteoprotegerin; Procollagen type I amino terminal propeptide (P1NP); Pyridinium crosslinks (pyridinoline, deoxypyridinoline); Receptor activator of nuclear factor kappa-B lig [...]
No biochemical markers (including serum or urinary collagen crosslinks or other BTMs) are established/covered for routine screening, diagnosis, or management of osteoporosis according to this CPB.
Aetna considers measurement of bone turnover markers experimental and investigational for diagnosis and monitoring of aseptic loosening and/or osteolysis related to wear or corrosion in total joint arthroplasty.
Aetna considers measurement of bone turnover markers experimental and investigational for persons receiving serotonergic antidepressants (i.e., NOT established/covered for evaluating bone effects in this population).
Aetna considers measurement of collagen crosslinks experimental and investigational for screening, diagnosis, or management of bisphosphonate-induced jaw osteonecrosis, chronic kidney disease, osteogenesis imperfecta, or other indications.

6 Active Policies

CIGNA-A004, Preventive Care Services

CIGNA-0398, Transvaginal Ultrasound, Non-Obstetrical

AETNA-CPB-0029, Thermography

AETNA-CPB-0212, Musculoskeletal Assessment Systems

AETNA-CPB-0562, Biochemical Markers of Bone Remodeling

AETNA-CPB-0608, Salivary Tests

`Z13.820`, Encounter for screening for osteoporosis

Prior Authorization

Documentation Required

Key Coverage Criteria

6 Active Policies

Related Codes

Have a follow-up question?

Z13.820, Encounter for screening for osteoporosis

Prior Authorization

Documentation Required

Key Coverage Criteria

6 Active Policies

Related Codes

Have a follow-up question?

`Z13.820`, Encounter for screening for osteoporosis