E40, Kwashiorkor
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Medical records must document the medical necessity of the serum magnesium test, including the signs, symptoms, and/or diagnosis that prompted the test.
- Laboratories must maintain the physician's order for the serum magnesium test in their records.
- Medical records must contain the serum magnesium lab test results.
- When requesting individual consideration through written redetermination, providers must include all relevant medical records and supporting literature.
Key Coverage Criteria
- Vitamin B12 injections are covered only when reasonable and necessary per Local Coverage Determination L33967.
- No specific clinical indications are listed in this article; follow the Local Coverage Determination (LCD) L39400 for indications for magnesium testing or services.
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- Anaplastic lymphoma kinase (ALK) testing as an alternative to FISH for selecting individuals for ALK inhibitor therapy
6 Active Policies
FIRST_COAST-L33967, Vitamin B<sub>12</sub> Injections
J9
CIGNA-0567, Serum Folate and Red Blood Cell Folate Testing
AETNA-CPB-0650, Polymerase Chain Reaction Testing: Selected Indications
A57189, Billing and Coding: Serum Magnesium
A57755, Billing and Coding: Vitamin B12 Injections
Related Codes
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