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ICD-10-CM Z84.82, Family history of sudden infant death syndrome | No Prior Auth

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`Z84.82`, Family history of sudden infant death syndrome

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Key Coverage Criteria

Serum iron testing is consideredmedically necessaryfor any of the following indications:
Evaluation of suspected iron deficiency in individuals who meet any of the following criteria:Abnormal blood counts consistent with iron deficiency including, but not limited to, the following:Decreased mean corpuscular volume (MCV);orDecreased hemoglobin/hematocrit when the MCV is low or normal;orIncreased red cell distribution width (RDW) and low or normal MCV;orEvidence of acute or chronic blood loss including, but not limited to, the following:Gastrointestinal blood loss;orHematuria;orMenorr [...]
Abnormal blood counts consistent with iron deficiency including, but not limited to, the following:Decreased mean corpuscular volume (MCV);orDecreased hemoglobin/hematocrit when the MCV is low or normal;orIncreased red cell distribution width (RDW) and low or normal MCV;or
Decreased mean corpuscular volume (MCV);or
Decreased hemoglobin/hematocrit when the MCV is low or normal;or
Increased red cell distribution width (RDW) and low or normal MCV;or

4 Active Policies

ANTHEM-CG-LAB-21, Serum Iron Testing

ANTHEM-CG-LAB-24, Outpatient Urine Culture

ANTHEM-CG-LAB-20, Thyroid Testing

ANTHEM-CG-LAB-30, Outpatient Laboratory-based Blood Glucose Testing

Related Codes

I50.1(4 policies)I50.9(3 policies)E08.00(3 policies)E13.9(3 policies)G93.31(3 policies)E75.26(3 policies)A15.0(3 policies)L29.9(3 policies)

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