R53.82 — Chronic fatigue, unspecified
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- Medical records must document that applicable LCD coverage criteria are met and that the test is expected to influence treatment; include relevant history, exam findings, problems/diagnoses, and data (labs, imaging) that support the ordering decision.
- The laboratory or billing provider must retain the physician requisition that specifies the diagnosis or condition (ICD-10-CM code) warranting the test.
- Performing laboratories must have, and provide when requested, documentation such as lab accreditation, test requisition, test records/procedures, preliminary and final reports, and quality control records.
- For laboratory-developed tests (LDTs) or protocols, documentation when requested must include the diagnostic assay, laboratory/manufacturer, names of comparable assays (if relevant), assay description, analytical validity, clinical validity, and clinical utility evidence.
Key Coverage Criteria
- MS testing is covered when performed in accordance with the applicable Local Coverage Determination (LCD) coverage guidelines for monoclonal gammopathy.
- Mass spectrometry (MS) testing is covered when the medical record documents that the testing is expected to influence the treatment or management of the condition for which the test is ordered.
- No specific clinical indications are listed in this article; follow the Local Coverage Determination (LCD) L39400 for indications for magnesium testing or services.
- Serum mass spectrometry (MS), with concurrent serum or urine immunofixation electrophoresis (sIFE/uIFE), is covered to confirm initial detection of M-protein when there is an abnormal serum protein electrophoresis (SPEP) or abnormal serum free light-chain (sFLC) test.
- Serum MS, with concurrent sIFE/uIFE, is covered to discriminate therapeutic monoclonal antibody(s) from endogenous M-protein(s) during patient monitoring.
- Serum MS, with concurrent sIFE/uIFE, is covered for assessment of treatment response when performed in accordance with accepted clinical guidelines.
17 Active Policies
L39189 — Mass Spectrometry (MS) Testing in Monoclonal Gammopathy (MG)
J06
A58921 — Billing and Coding: Mass Spectrometry (MS) Testing in Monoclonal Gammopathy (MG)
J06
AETNA-CPB-0049 — Nutritional Counseling
AETNA-CPB-0158 — Neuropsychological and Psychological Testing
AETNA-CPB-0322 — Electroencephalographic (EEG) Video Monitoring
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