P05.00 — Newborn light for gestational age, unspecified weight
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Key Coverage Criteria
- Vitamin B12 blood testing is consideredmedically necessaryforanyof the following indications:
- Alcohol dependence;or
- Autoimmune condition such as intrinsic factor deficiency, thyroid disease, or pernicious anemia;or
- Blood dyscrasia (for example cytopenia, leukopenia, or thrombocytopenia);or
- Diabetes mellitus with neurologic symptoms;or
- Disorders of sulphur amino acid metabolism;or
4 Active Policies
ANTHEM-CG-LAB-19 — CG-LAB-19 Laboratory Evaluation of Vitamin B12
ANTHEM-CG-LAB-20 — CG-LAB-20 Thyroid Testing
ANTHEM-CG-LAB-25 — CG-LAB-25 Outpatient Glycated Hemoglobin and Protein Testing
ANTHEM-CG-LAB-30 — CG-LAB-30 Outpatient Laboratory-based Blood Glucose Testing
Related Codes
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