Does Z77.011 require prior authorization?

No, Z77.011 does not require prior authorization (high confidence). Covered without prior authorization.

`Z77.011`, Contact with and (suspected) exposure to lead

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation of the clinical indication or the applicable ICD-10 diagnosis code from the list of covered diagnoses when submitting CPT/diagnosis codes for reimbursement (e.g., listed ICD-10 codes such as D50.*, F98.3, T56.0X*, Z77.011, etc.).
For occupational lead exposure screening, documentation of workplace lead exposure per OSHA requirements or employer/occupational exposure records supporting occupational exposure status.
For pregnant or lactating women, documentation that at least one risk factor for lead exposure (from the Appendix table) was identified on risk assessment (ACOG-recommended risk assessment at earliest contact).
Documentation of signs or symptoms of lead poisoning when testing is performed for diagnostic purposes (examples in policy: lowered IQ, decreased attention span, impaired hearing/speech/developmental delays, abdominal pain, headaches, vomiting, constipation).

Screening of preschool-age children in the following high-risk groups: abnormal oral behaviors (e.g., pica) placing them at risk.
Screening of preschool-age children in the following high-risk groups: close contact with a person who has or had an elevated lead level.
Lead screening for persons with occupational lead exposures (OSHA-mandated testing for workplace lead exposures).
Screening of preschool-age children in the following high-risk groups: emigrated (or adopted) from countries where lead poisoning is prevalent.
Screening of preschool-age children in the following high-risk groups: have iron deficiency.
Screening of preschool-age children in the following high-risk groups: have unexplained illness (e.g., abdominal pain, lethargy, seizures, severe anemia).

ANTHEM-CG-MED-90, Chelation Therapy

AETNA-CPB-0553, Lead Testing

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