82747
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Submission must include an appropriate covered ICD-10-CM diagnosis code from the policy (claims for diagnosis codes not listed will be denied).
- Clinical documentation supporting the specific covered indication: for serum folate (CPT 82746) — documentation of suspected folate deficiency and the associated context (e.g., anemia with folate in the differential, neural tube defect/neurologic disorder where folate deficiency is possible, malabsorption/digestive disease, eating disorder, or monitoring of folate deficiency treatment).
- For RBC folate (CPT 82747) — documentation that the test is part of the initial evaluation of cytopenia(s) and that myelodysplasia is suspected (e.g., CBC results demonstrating cytopenia(s), peripheral smear findings, and clinical rationale for evaluating MDS).
Key Coverage Criteria
- Serum folate testing (CPT® 82746) is considered medically necessary for EITHER of the following: Suspected diagnosis of folate deficiency associated with ANY of the following:
- Anemia, where folate deficiency is in the differential diagnosis (e.g., megaloblastic anemia with or without other associated cytopenias).
- Neural tube defects and neurologic disorders where folate deficiency is known to be a potential underlying cause.
- Diseases of the digestive system associated with malabsorption.
- Eating disorders.
- Monitoring treatment of folate deficiency.
3 Active Policies
CIGNA-0567 — Serum Folate and Red Blood Cell Folate Testing - (0567)
ANTHEM-CG-LAB-15 — CG-LAB-15 Red Blood Cell Folic Acid Testing
REGENCE-LAB79 — Folate Testing
Related Codes
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