Does E78.41 require prior authorization?

No, E78.41 does not require prior authorization (high confidence). Code is covered without prior authorization.

`E78.41` — Elevated Lipoprotein(a)

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medical record must document suspected B12 or folate deficiency or the specific ICD-10-CM code from LCD L34419 supporting risk stratification medical necessity.
For repeat testing, medical records must document prior appropriate treatment and objective evidence that the treatment did not correct the anemia or symptoms.
Claims should reference the applicable ICD-10-CM diagnosis code(s) that support medical necessity per LCD L34419.
Claims should be supported with documentation consistent with LCD L36129; this article provides billing and coding guidelines that complement that LCD and should be used alongside the LCD when submitting claims.

Serum homocysteine testing is covered for evaluation of suspected vitamin B12 (cobalamin) deficiency.
Serum homocysteine testing is covered for risk stratification for the conditions listed in the ICD-10-CM Codes that Support Medical Necessity in LCD L34419.
Serum homocysteine testing is covered for evaluation of suspected folate (vitamin B9) deficiency.
No clinical indications are specified in this article; coverage indications are determined by the referenced LCD L36362 (MolDX: Biomarkers in Cardiovascular Risk Assessment).
For covered laparoscopic restrictive procedures that require port replacement, bill CPT code 43771, 43772, or 43773.
Follow the LCD L33411 reasonable and necessary requirements for surgical management of morbid obesity when determining coverage.

A57559 — Billing and Coding: MolDX: Biomarkers in Cardiovascular Risk Assessment

J05

L36523 — MolDX: Biomarkers in Cardiovascular Risk Assessment

J05

L33411 — Surgical Management of Morbid Obesity

J09

A57145 — Billing and Coding: Surgical Management of Morbid Obesity

J09

A57055

Ask Verity about documentation requirements, denial risks, or coverage in your state.