Does R79.1 require prior authorization?

No, R79.1 does not require prior authorization (high confidence). Code is covered without prior authorization.

`R79.1` — Abnormal coagulation profile

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

The submitted medical record must support the selected ICD-10-CM code(s), and the submitted CPT/HCPCS code must accurately describe the service performed.
The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
When billing CPT 84999 for the listed tests, include a note identifying the specific test in the Remarks (Part A) or Narrative (Part B) area of the claim.
All documentation must be maintained in the patient's medical record, be legible, include patient identification (e.g., complete name) and dates of service, and be made available to the contractor upon request.

For tests that currently lack specific CPT codes (functional intracellular analysis and total antioxidant function), bill using CPT 84999 and add a note identifying which test was performed in the Remarks area for Part A claims and the Narrative area for Part B claims.
Coverage and reasonable/necessary determinations for assays for vitamins and metabolic function are governed by LCD L34914 and claims must meet that LCD's requirements to be covered.
Non-invasive vascular studies (duplex scan, physiologic studies, plethysmography, transcranial Doppler) are covered when ordered by the treating or consulting practitioner and medically necessary to evaluate, diagnose, or manage vascular disease.
Initial autogenous access vessel mapping should be billed with HCPCS codes 93985 or 93986 and is covered when medically necessary for surgical planning.
Subsequent autogenous access mapping may be billed with CPT codes 93970 or 93971 when clinically indicated.
Pre-surgical radial artery conduit mapping may be performed and accompanied by vein-mapping when either study shows insufficient conduits for multiple bypass procedures.

A56758 — Billing and Coding: Non-Invasive Vascular Studies

J06

L33627 — Non-Invasive Vascular Studies

J06

A56416 — Billing and Coding: Assays for Vitamins and Metabolic Function

J12

L34914 — Assays for Vitamins and Metabolic Function

J12

AMBETTER-CG-Hema-Cond-(nonCA)--2025.1

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