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ICD-10-CM Z83.42, Family history of familial hypercholesterolemia | No Prior Auth

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`Z83.42`, Family history of familial hypercholesterolemia

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Key Coverage Criteria

Renal transplant recipients who are ABO compatible who are experiencing antibody mediated rejection (AMR) or require desensitization (living donor)
Wilsonâs disease - fulminant
Renal transplant recipients who are ABO incompatible and require desensitization (living donor)
Plasmapheresis or plasma exchange is consideredmedically necessaryfor any of the following conditions listed in alphabetical order below:Acute inflammatory demyelinating polyradiculoneuropathy / Guillain-Barre syndromeAnti-glomerular basement membrane disease (Goodpasture's syndrome) when the individual is dialysis-independent or there is evidence of diffuse alveolar hemorrhage (DAH)Atypical hemolytic uremic syndrome (aHUS) with Factor H autoantibodies or complement gene mutationAutoimmune hemol [...]
Acute inflammatory demyelinating polyradiculoneuropathy / Guillain-Barre syndrome
Anti-glomerular basement membrane disease (Goodpasture's syndrome) when the individual is dialysis-independent or there is evidence of diffuse alveolar hemorrhage (DAH)

1 Active Policy

ANTHEM-CG-MED-68, Therapeutic Apheresis

Related Codes

36511(1 policies)36512(1 policies)36513(1 policies)36514(1 policies)36515(1 policies)36516(1 policies)B60.0(1 policies)00113(1 policies)

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