R62.52 — Short stature (child)
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Documentation that the member's clinical presentation is not specific to a well-delineated genetic syndrome when applicable.
- For children with congenital anomalies: documentation of the malformation criteria (two or more major malformations; or a single major malformation or multiple minor malformations in an infant/child born with IUGR or small for gestational age; or a single major malformation and multiple minor malformations).
- For DD/ID or ASD: documentation that targeted genetic testing (e.g., FMR1 for Fragile X) was performed and is negative when indicated by clinical/family history.
- Documentation of evaluation and recommendation that CGH is warranted by a Board-Certified or Board-Eligible Medical Geneticist, Developmental/Behavioral Pediatrician, Pediatric or Adult Neurologist.
Key Coverage Criteria
- Diagnosing genetic abnormalities in children with congenital anomalies when ALL of the following criteria are met: the member's clinical presentation is not specific to a well-delineated genetic syndrome; and the child has one or more of the following (see Appendix): two or more major malformations; or a single major malformation or multiple minor malformations in an infant or child that was born with intrauterine growth restriction (IUGR) or was small for gestational age; or a single major malf [...]
- Diagnosing genetic abnormalities in children with intellectual disability (DD/ID) or autism spectrum disorder (ASD) (per DSM-5) when ALL of the following criteria are met: targeted genetic testing (for example: FMR1 gene analysis for Fragile X), if/when indicated by clinical and family history, is negative; the member's clinical presentation is not specific to a well-delineated genetic syndrome; the member has been evaluated by a Board-Certified or Board-Eligible Medical Geneticist, Developmenta [...]
- Evaluating fetuses with structural abnormalities detected on fetal ultrasound or fetal magnetic resonance imaging.
- Evaluating histologically equivocal Spitzoid melanocytic neoplasms (Spitz nevus and atypical Spitz tumors).
- For pregnant women undergoing invasive prenatal diagnostic testing (amniocentesis or chorionic villus sampling) for any indication.
- Analyses of fetal tissue (i.e., amniotic fluid, placenta, or products of conception) in the evaluation of intrauterine fetal death or stillbirth (which is 20 weeks gestation and greater).
4 Active Policies
AMBETTER-CG-Multi-Inher-DO.-Intel-Dis.-DD-2025.1 — Concert Genetic Testing: Multisystem Inherited Disorders, Intellectual Disability, and Developmental Delay
AETNA-CPB-0220 — Distraction Osteosynthesis
AETNA-CPB-0711 — Mecasermin (Increlex)
AETNA-CPB-0787 — Comparative Genomic Hybridization (CGH)
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.