Does E88.89 require prior authorization?

No, E88.89 does not require prior authorization (high confidence). Code is covered without prior authorization.

`E88.89` — Other specified metabolic disorders

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

This billing and coding article provides guidelines that complement Local Coverage Determination L34415 for CT of the abdomen and pelvis; consult LCD L34415 for specific coverage indications, limitations, and documentation requirements.
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.
Billing, coding, and guideline information herein complement and must be used in conjunction with the Local Coverage Determination MolDX: Biomarkers in Cardiovascular Risk Assessment (LCD L36358); follow LCD L36358 for clinical criteria and claim adjudication.
Required documentation and claim substantiation should follow the documentation requirements and MolDX program instructions in LCD L36362; no additional specific forms or certifications are specified in this article.

No clinical indications are specified in this article; coverage indications are determined by the referenced LCD L36362 (MolDX: Biomarkers in Cardiovascular Risk Assessment).
Therapeutic respiratory procedures (HCPCS G0237, G0238, G0239) using an individualized physical conditioning and exercise program with breathing techniques are covered for patients with documented activity limitations.
Pulmonary function tests (PFTs) represented by CPT codes 94070, 94200, 94640, 94726, 94727, and 94729 are covered when reasonable and medically necessary with supporting clinical documentation and a written order by a physician or appropriate NPP.
Spirometry (CPT 94010, 94011, 94012, 94060, 94070, 94150, 94200, 94375, 94726, 94727) is covered when clinically indicated and documented in the medical record.
Lung volume determination (CPT 94013, 94726, 94727, 94728) and diffusion capacity testing (CPT 94729) are covered when medically necessary and documented.
Pulmonary stress testing (CPT 94617, 94618, 94619, 94621) is covered when clinically indicated and supported by the medical record.

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

J05

L36523 — MolDX: Biomarkers in Cardiovascular Risk Assessment

J05

A57327 — Billing and Coding: Electrocardiograms

AETNA-CPB-0016 — Back Pain - Invasive Procedures

AETNA-CPB-0067 — Chest Physiotherapy and Airway Clearance Devices

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