83550
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Medical record documentation of a complete history and physical examination.
- Documented parent/child interview or patient interview containing DSM-5 diagnostic criteria and findings.
- Results of collateral assessments when available (for example, Vanderbilt or Conners questionnaires).
- Psychiatric evaluation report or clinical notes from psychiatrist, psychologist, or other behavioral health professional.
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
3 Active Policies
AMBETTER-CP.BH.124 — Attention Deficit Hyperactivity Disorder Assessment and Treatment
ANTHEM-CG-LAB-21 — CG-LAB-21 Serum Iron Testing
REGENCE-LAB80 — Screening Laboratory Testing
Related Codes
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