E67.2 — Megavitamin-B6 syndrome
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation 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.
- All documentation must be maintained in the patient's medical record, be legible, include patient identification (e.g., complete name) and dates of service, and be made available to the contractor upon request.
Key Coverage Criteria
- 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.
- ICD-10-CM Codes that Support Medical Necessity — Group 1 (covered diagnoses): D56.1 - Beta thalassemia
- ICD-10-CM Codes that Support Medical Necessity — Group 1 (covered diagnoses): D57.02 - Hb-SS disease with splenic sequestration
- ICD-10-CM Codes that Support Medical Necessity — Group 1 (covered diagnoses): D57.1 - Sickle-cell disease without crisis
- ICD-10-CM Codes that Support Medical Necessity — Group 1 (covered diagnoses): D57.212 - Sickle-cell/Hb-C disease with splenic sequestration
9 Active Policies
L34658 — Vitamin D Assay Testing
J05
A57484 — Billing and Coding: Vitamin D Assay Testing
J05
L34914 — Assays for Vitamins and Metabolic Function
J12
A56416 — Billing and Coding: Assays for Vitamins and Metabolic Function
J12
A57198 — Billing and Coding: Serum Magnesium
Related Codes
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