D68.2 — Hereditary deficiency of other clotting factors
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Policy content not provided; unable to determine required documentation, prior authorization, or forms for AICC claims—manual review of the full policy required.
- The submitted medical record must support the selected ICD-10-CM code(s), and the submitted CPT/HCPCS code must accurately describe the service performed.
- The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
- When billing CPT 84999 for the listed tests, include a note identifying the specific test in the Remarks (Part A) or Narrative (Part B) area of the claim.
Key Coverage Criteria
- Policy content not provided; unable to determine covered indications for AICC NCD 110.3—manual review of the full policy required.
- For tests that currently lack specific CPT codes (functional intracellular analysis and total antioxidant function), bill using CPT 84999 and add a note identifying which test was performed in the Remarks area for Part A claims and the Narrative area for Part B claims.
- Coverage and reasonable/necessary determinations for assays for vitamins and metabolic function are governed by LCD L34914 and claims must meet that LCD's requirements to be covered.
- Routine foot care is covered only when clinical documentation demonstrates the patient’s condition warrants the provider to render the services and that failure to provide the services would be hazardous to the beneficiary due to underlying medical condition(s), per CMS Pub 100-02, Ch.15, §290.
- Targeted single vitamin assays are covered when reasonable and necessary for diagnosis or treatment of a specific suspected vitamin deficiency documented by history and focused physical exam.
- Laboratory testing for a specific vitamin deficiency is covered when specific clinical findings suggest that deficiency (e.g., signs/symptoms or physical exam findings consistent with that vitamin deficiency).
7 Active Policies
A56416 — Billing and Coding: Assays for Vitamins and Metabolic Function
J12
L34914 — Assays for Vitamins and Metabolic Function
J12
A57957 — Billing and Coding: Routine Foot Care
AMBETTER-CG-Hema-Cond-(nonCA)--2025.1 — Concert Genetic Testing: Hematologic Conditions (non-cancerous)
A57954 — Billing and Coding: Routine Foot Care
Related Codes
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