Does Z83.79 require prior authorization?

No, Z83.79 does not require prior authorization (high confidence). Covered without prior authorization.

`Z83.79`, Family history of other diseases of the digestive system

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service).
The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
The submitted medical record must support the use of the selected ICD-10-CM code(s).

Esophagogastroduodenoscopy (EGD) is covered when it meets the reasonable and necessary requirements specified in Local Coverage Determination L33583.
Persons with discrepant celiac-specific serology and histology;
Serological testing of IgA anti-human tissue transglutaminase (TTG) antibodies, IgG and IgA deamidated gliadin antibodies (DGP), and IgA anti-endomysial antibodies (EMA) for any of the following indications:
As a preliminary diagnostic test for persons with symptoms suggestive of celiac disease;
To monitor response to a gluten-free diet;
To screen first-degree relatives of individuals with celiac disease;

FIRST_COAST-L33583, Diagnostic and Therapeutic Esophagogastroduodenoscopy

A57063, Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy

AMBETTER-CG-Gastro-Disorders-NonCa-2025.1, Concert Genetic Testing: Gastroenterologic Disorders (non-cancerous)

AETNA-CPB-0561, Celiac Disease Laboratory Testing

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