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ICD-10-CM Z79.631, Long term (current) use of antimetabolite agent | No Prior Auth

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`Z79.631`, Long term (current) use of antimetabolite agent

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

The medical record must clearly document the necessity for the vitamin D test(s), including the clinical indication, and must document any repeat testing and the frequency of repeat testing.
Medical records relating to the test must be made available to Medicare upon request.
Providers must follow Correct Coding Initiative (CCI) guidance for correct HCPCS/CPT coding and appropriate code combinations prior to billing Medicare; documentation must support the CPT/HCPCS codes billed.
The article provides billing/coding guidance that complements LCD L39400; use the documentation, prior authorization, and claim submission requirements specified in LCD L39400 and the local contractor's instructions.

Key Coverage Criteria

Vitamin D assay testing is covered when the medical record documents medical necessity for the test, including the clinical reason for testing and any planned repeat testing and frequency.
No specific clinical indications are listed in this article; follow the Local Coverage Determination (LCD) L39400 for indications for magnesium testing or services.

2 Active Policies

A57718, Billing and Coding: Vitamin D Assay Testing

A59186, Billing and Coding: Magnesium

Related Codes

E20.812(2 policies)E20.89(2 policies)E20.810(2 policies)E20.811(2 policies)E20.818(2 policies)E20.819(2 policies)E20.0(2 policies)E20.9(2 policies)

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