R73.03 — Prediabetes
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- This article provides billing, coding and guideline information that complements Local Coverage Determination (LCD) L33431 for HbA1c; refer to LCD L33431 for clinical coverage criteria and specific documentation requirements.
- Select and report the appropriate CPT or PLA code for the biomarker test.
- Enter 1 unit of service (UOS) on the claim for the test.
- For Part B claims, enter the appropriate DEX Z-Code identifier adjacent to the CPT code in the comment/narrative field: Loop 2400 or SV101-7 for 837P electronic claims, or Box 19 for paper claims.
Key Coverage Criteria
- Biomarker testing for risk stratification in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and Metabolic Dysfunction-Associated Steatohepatitis (MASH) in accordance with LCD DL40187.
- Biomarker testing for risk stratification is covered when ordered for patients with Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) or Metabolic Dysfunction-Associated Steatohepatitis (MASH).
- Biomarker testing for risk stratification in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and Metabolic Dysfunction-Associated Steatohepatitis (MASH).
- Biomarker testing for risk stratification in metabolic dysfunction-associated steatotic liver disease (MASLD) or metabolic dysfunction-associated steatohepatitis (MASH) is covered when the clinical coverage criteria of LCD DL40272 are met and an appropriate CPT or PLA code is reported.
- Perform HbA1c testing at least twice per year in patients who are meeting individualized treatment goals and have stable glycemic control, defined as two consecutive HbA1c results meeting treatment goals.
- Perform HbA1c testing for beneficiaries with unstable or uncontrolled glycemia at intervals up to once every 3 months as allowed by the Lab NCD 190.21.
11 Active Policies
L40271 — MolDX: Biomarker Testing for Risk Stratification in Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis
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A60305 — Billing and Coding: MolDX: Biomarker Testing for Risk Stratification in Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis
J05
A60204 — Billing and Coding: MolDX: Biomarker Testing for Risk Stratification in Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis
A60214 — Billing and Coding: MolDX: Biomarker Testing for Risk Stratification in Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis
Related Codes
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