N92.2 — Excessive menstruation at puberty
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Clinical documentation describing the bleeding manifestation(s) (type, severity, timing, relation to trauma or procedures).
- Clinical documentation demonstrating the member has clinical features of hemophilia to support genetic testing (per policy criteria).
- Provide hematologic screening results (examples: MCV, MCH, CBC, hemoglobin electrophoresis, dichlorophenol indophenol (DCIP)) showing either positive findings for a hemoglobinopathy or inconclusive results that do not rule out a hemoglobinopathy.
- Laboratory results showing platelet count (normal), aPTT (prolonged) and PT (normal) with dates and values.
Key Coverage Criteria
- Genetic testing for non-cancerous hematologic conditions to confirm a diagnosis in patients with signs and/or symptoms of a specific hematologic condition.
- Genetic testing when confirmation of a hematologic diagnosis may alter patient management or eliminate the need for further diagnostic workup.
- Genetic testing for Factor V (Leiden) and Prothrombin (F2) 20210G>A variants when evaluating inherited thrombophilia or personal/family history of venous thromboembolism.
- Alpha- and beta-globin (HBA1/HBA2 and HBB) variant and dosage analysis for evaluation of suspected alpha thalassemia, beta thalassemia, sickle cell disease, or related hemoglobinopathies.
- Factor VIII (F8) and Factor IX (F9) genetic analysis for diagnosis/evaluation of Hemophilia A and Hemophilia B.
- G6PD gene variant analysis (targeted testing or full gene sequencing/deletion-duplication) for evaluation of suspected glucose-6-phosphate dehydrogenase deficiency.
1 Active Policy
AMBETTER-CG-Hema-Cond-(nonCA)--2025.1 — Concert Genetic Testing: Hematologic Conditions (non-cancerous)
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.