R93.7 — Abnormal findings on diagnostic imaging of other parts of musculoskeletal system
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Verify and document compliance with applicable NCCI edits and OPPS packaging rules prior to billing.
- Include a valid ICD-10-CM diagnosis code on the claim that best describes the patient's condition for which the heavy metal test was performed.
- For diagnostic heavy metal tests, report the test result on the claim if known; if the result is not known, report the symptoms that prompted the test.
- When required, report the referring/ordering physician's name and NPI on the claim.
Key Coverage Criteria
- MRA (with or without contrast) is covered when it can replace a more invasive diagnostic test (e.g., contrast angiography) and thereby reduce risk to the beneficiary.
- MRA is covered for diagnosis and assessment of diseases and abnormalities of the arterial, venous, and lymphatic systems at any anatomic location when reasonable and necessary for the specific patient's diagnosis or treatment.
- Coverage and definition of MRA are subject to the CMS Internet-Only Manual, Pub. 100-03, Medicare NCD Manual, Chapter 1, Part 4, §220.2; MRA is considered appropriate consistent with that NCD.
- Serum thallium testing is covered for beneficiaries with documented industrial thallium exposure and unexplained ataxia.
- Serum tin testing is covered for beneficiaries with documented industrial tin exposure.
- Serum aluminum testing is covered for beneficiaries on chronic dialysis with evidence suggesting aluminum toxicity or for beneficiaries with documented chronic industrial aluminum exposure.
6 Active Policies
A56767 — Billing and Coding: Heavy Metal Testing
J06
L35074 — Heavy Metal Testing
J06
A59845 — Billing and Coding: Magnetic Resonance Angiography
ANTHEM-CG-LAB-28 — CG-LAB-28 Prostate Specific Antigen Testing
A56775 — Billing and Coding: Magnetic Resonance Angiography
Related Codes
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