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ICD-10-CM Z87.898, Personal history of other specified conditions | No Prior Auth

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`Z87.898`, Personal history of other specified conditions

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

No specific documentation requirements, prior authorization criteria, or required clinical documentation are specified in this CPB for behavioral vision therapy or vision restoration therapy.
General clinical rationale in the policy cites lack of validated evidence from well-designed prospective clinical studies as the basis for considering these therapies experimental/investigational.

Key Coverage Criteria

Thyroid function testing is consideredmedically necessaryfor individuals who meet any of the following indications:
For evaluation of signs or symptoms consistent with thyroid disease;or
To evaluate, assess, or monitor confirmed or suspected thyroid disease;or
To evaluate thyroid function when there are risk factors for thyroid disease.

2 Active Policies

ANTHEM-CG-LAB-20, Thyroid Testing

AETNA-CPB-0321, Behavioral Vision Therapy and Vision Restoration Therapy

Related Codes

R49.0(2 policies)R62.0(2 policies)R49.9(2 policies)84443(1 policies)97533(1 policies)A15.0(1 policies)92065(1 policies)A19.9(1 policies)

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