Does Z79.890 require prior authorization?

No, Z79.890 does not require prior authorization (high confidence). Covered without prior authorization.

`Z79.890`, Hormone replacement therapy

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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.
For services requiring a referring/ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.

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.
Medicare may cover injectable testosterone pellets (Testopel) for males when used for an FDA‑approved indication and when the service meets Medicare coverage requirements in CMS Medicare Benefit Policy Manual, Chapter 15, §50.4.3.
Injectable testosterone pellet therapy may be used when alternative accepted routes (transdermal, oral, nasal, intramuscular) are clinically inappropriate or insufficient and medical necessity is documented.
HCPCS code C1782 (Morcellator) may be covered when selection criteria for morcellation exceptions are met.
Treatment of uterine fibroids (uterine leiomyoma; ICD-10: D25.0 - D25.9) when the member has persistence of one or more symptoms directly attributed to uterine fibroids, including: excessive menstrual bleeding (menorrhagia), bulk-related pelvic pain, pressure or discomfort, urinary symptoms referable to compression of the ureter or bladder, and/or dyspareunia.
Radiofrequency ablation (open, laparoscopic e.g., the Acessa System, or transcervical e.g., the Sonata System) medically necessary as an alternative to hysterectomy or myomectomy for treatment of symptomatic uterine fibroids when the above symptom criteria are met.

A57736, Billing and Coding: Vitamin D Assay Testing

NGS-J6-L37535, Vitamin D Assay Testing

NGS-JK-L37535, Vitamin D Assay Testing

AETNA-CPB-0304, Fibroid Treatment

AETNA-CPB-0327, Infertility

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