Z01.21 — Encounter for dental examination and cleaning with abnormal findings
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Laboratory tests are not covered unless they are ordered by a physician or other qualified health professional. Please check benefit plan descriptions.
- For use of late-night salivary cortisol in diagnosing Cushing's syndrome: exclude exogenous glucocorticoid use and perform testing in patients with multiple and progressive features compatible with the syndrome and patients with adrenal incidentaloma (per Endocrine Society guideline text in policy).
- No explicit Medicare documentation or billing requirements are specified in the provided text.
- If screening tests (e.g., late-night salivary cortisol or urine cortisol) are positive, a confirmatory second test is recommended and patients should be referred to an endocrinologist (per Endocrine Society guideline text in policy).
Key Coverage Criteria
- Use of the CDOT salivary test in settings such as dentist offices, primary care centers and specialized cancer clinics to aid early detection (as suggested by the authors)
- The test was validated in former and current smokers and in younger and older participants (study populations in which the model was evaluated)
- Late night salivary cortisol for diagnosing Cushing's syndrome.
- ICD-10 covered diagnosis for this indication: E24.0 - E24.9 (Cushing's syndrome).
- Use of salivary lactate dehydrogenase (SaLDH) as a potential biomarker for screening, early detection, and follow-up of oral potentially malignant disorders (OPMD) and head and neck cancer (HNC).
- Use of salivary biomarkers (including SaLDH and other salivary molecular markers) for detection/diagnosis of oral cancer and head & neck cancers (general statement supported by systematic reviews/meta-analyses).
1 Active Policy
AETNA-CPB-0608 — Salivary Tests
Related Codes
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