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ICD-10-CM Z84.89, Family history of other specified conditions | No Prior Auth

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`Z84.89`, Family history of other specified conditions

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Clinical documentation supporting a suspected or confirmed clinical diagnosis of hereditary arrhythmia or cardiomyopathy.
Documentation that the decision to test and interpretation of results were performed by, or in consultation with, an expert in cardiac genetics.
For cascade testing, documentation of the pathogenic or likely pathogenic variant identified in the affected proband to justify testing of asymptomatic relatives.
Refer to the Concert Platform for a comprehensive list of registered tests and related coding information.

Key Coverage Criteria

Post–heart transplant peripheral blood gene expression panels to assess rejection risk.
ARVC confirmed in a first-degree relative who meets current Task Force Criteria.
ARVC confirmed pathologically at autopsy or surgery in a first-degree relative.
Family history of juvenile sudden cardiac death triggered by exercise or acute emotion.
Exercise-induced bidirectional or polymorphic ventricular arrhythmias.
Ventricular fibrillation occurring in the setting of acute stress.

1 Active Policy

AMBETTER-CG-Cardiac-Disorders-2025.1, Concert Genetic Testing: Cardiac Disorders

Related Codes

0118U(1 policies)0237U(1 policies)0493U(1 policies)81401(1 policies)81403(1 policies)81404(1 policies)81405(1 policies)0087U(1 policies)

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Submit clinical documentation supporting the diagnosis or indication being tested (e.g., pertinent clinical notes, ECG/hospital records) corresponding to the ICD-10-CM code(s) submitted.

Specify the exact genetic panel ordered (panel name and performing laboratory) on the test requisition.