Does P70.2 require prior authorization?

No, P70.2 does not require prior authorization (high confidence). Code is covered without prior authorization.

`P70.2` — Neonatal diabetes mellitus

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

I.Non-ImplantedContinuous Interstitial Glucose Monitoring Devices for Personal Use
Use of anon-implantedcontinuous interstitial glucose monitoring device for personal use is consideredmedically necessaryfor individuals who meet the following criteria:
Individual has been diagnosed with diabetes mellitus (any type);and
Insulin injections are required multiple times daily or an insulin pump is used for maintenance of blood sugar control;and
Both of the following (1 and 2):The individual or caregiver(s) demonstrates the following:An understanding of the technology, including use of the device to recognize alerts and alarms;andMotivation to use the device correctly and consistently;andContinued participation in a comprehensive diabetes treatment plan;andAnyof the following are present, despite ongoing management using self-monitoring and insulin administration regimens to optimize care:Inadequate glycemic control, demonstrated by HbA [...]
The individual or caregiver(s) demonstrates the following:An understanding of the technology, including use of the device to recognize alerts and alarms;andMotivation to use the device correctly and consistently;andContinued participation in a comprehensive diabetes treatment plan;and

ANTHEM-CG-DME-42 — CG-DME-42 Continuous Glucose Monitoring Devices

ANTHEM-MP-A046252 — Pre-Merger Organizations

ANTHEM-CG-MED-35 — CG-MED-35 Retinal Telescreening Systems

ANTHEM-CG-DME-51 — CG-DME-51 External Insulin Pumps

ANTHEM-CG-DME-50 — CG-DME-50 Automated Insulin Delivery Systems

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