A52.74 — Syphilis of liver and other viscera
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Key Coverage Criteria
- Outpatient alpha-fetoprotein testing is consideredmedically necessaryfor any of the following indications:
- Screening for neural tube defects in pregnant persons;or
- Evaluation or management of the following conditions:Carcinoma of unknown primary site;orGerm cell tumors;orHepatocellular carcinoma (HCC): diagnosed HCC, suspected HCC, or for those at high risk for HCC;orMediastinal mass;orOvarian cancer;orPelvic mass;orRetroperitoneal mass;orTesticular cancer or suspicious testicular mass;orThymoma or thymic cancer.
- Carcinoma of unknown primary site;or
- Germ cell tumors;or
- Hepatocellular carcinoma (HCC): diagnosed HCC, suspected HCC, or for those at high risk for HCC;or
1 Active Policy
ANTHEM-CG-LAB-26 — CG-LAB-26 Outpatient Alpha-Fetoprotein Testing
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.