O09.A3 — Supervision of pregnancy with history of molar pregnancy, third trimester
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Key Coverage Criteria
- Serum iron testing is consideredmedically necessaryfor any of the following indications:
- Evaluation of suspected iron deficiency in individuals who meet any of the following criteria:Abnormal blood counts consistent with iron deficiency including, but not limited to, the following:Decreased mean corpuscular volume (MCV);orDecreased hemoglobin/hematocrit when the MCV is low or normal;orIncreased red cell distribution width (RDW) and low or normal MCV;orEvidence of acute or chronic blood loss including, but not limited to, the following:Gastrointestinal blood loss;orHematuria;orMenorr [...]
- Abnormal blood counts consistent with iron deficiency including, but not limited to, the following:Decreased mean corpuscular volume (MCV);orDecreased hemoglobin/hematocrit when the MCV is low or normal;orIncreased red cell distribution width (RDW) and low or normal MCV;or
- Decreased mean corpuscular volume (MCV);or
- Decreased hemoglobin/hematocrit when the MCV is low or normal;or
- Increased red cell distribution width (RDW) and low or normal MCV;or
3 Active Policies
ANTHEM-CG-LAB-21 — CG-LAB-21 Serum Iron Testing
ANTHEM-CG-LAB-27 — CG-LAB-27 Human Chorionic Gonadotropin Testing
ANTHEM-CG-RAD-26 — CG-RAD-26 Maternity Ultrasound in the Outpatient Setting
Related Codes
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