Does Z49.31 require prior authorization?

No, Z49.31 does not require prior authorization (high confidence). Covered without prior authorization.

`Z49.31`, Encounter for adequacy testing for hemodialysis

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Medical records must document the medical necessity of the serum magnesium test, including the signs, symptoms, and/or diagnosis that prompted the test.
Laboratories must maintain the physician's order for the serum magnesium test in their records.
Medical records must contain the serum magnesium lab test results.
When requesting individual consideration through written redetermination, providers must include all relevant medical records and supporting literature.

No specific clinical indications are listed in this article; follow the Local Coverage Determination (LCD) L39400 for indications for magnesium testing or services.
None — Aetna considers the Crit-Line In-Line Monitor (In-Line Diagnostics, Kaysville, UT) experimental and investigational for monitoring hematocrit and oxygen saturation of members because the effectiveness of the Crit-Line In-Line Monitor in avoiding intra-dialytic morbid events, in preventing ischemia due to intra-dialytic hypoxia, and in determining access re-circulations has not been proven.
Serum iron testing is consideredmedically necessaryfor any of the following indications:
Evaluation of suspected iron deficiency in individuals who meet any of the following criteria:Abnormal blood counts consistent with iron deficiency including, but not limited to, the following:Decreased mean corpuscular volume (MCV);orDecreased hemoglobin/hematocrit when the MCV is low or normal;orIncreased red cell distribution width (RDW) and low or normal MCV;orEvidence of acute or chronic blood loss including, but not limited to, the following:Gastrointestinal blood loss;orHematuria;orMenorr [...]
Abnormal blood counts consistent with iron deficiency including, but not limited to, the following:Decreased mean corpuscular volume (MCV);orDecreased hemoglobin/hematocrit when the MCV is low or normal;orIncreased red cell distribution width (RDW) and low or normal MCV;or
Decreased mean corpuscular volume (MCV);or

ANTHEM-CG-LAB-21, Serum Iron Testing

AETNA-CPB-0373, Crit-Line In-Line Monitor

A57189, Billing and Coding: Serum Magnesium

A59186, Billing and Coding: Magnesium

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