Z68.52 — Body mass index [BMI] pediatric, 5th percentile to less than 85th percentile for age
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Refer to the applicable state Medicaid manual for any coverage provisions affecting Medicaid members.
- Review relevant Medicare NCDs, LCDs, and Medicare Coverage Articles on the CMS website prior to applying this policy for Medicare members.
- Clinical documentation of measured stature and serial height velocity.
- Documentation comparing the patient's stature/height velocity to genetic/familial potential and pubertal stage to justify endocrine testing.
Key Coverage Criteria
- Measurement of 25-hydroxyvitamin D (25-OH-D) concentration is appropriate for screening for vitamin D deficiency.
- Screening for vitamin D deficiency in children identified as high-risk based on clinical factors (targeted screening rather than universal screening).
- 25(OH)D testing for children/adolescents with conditions associated with reduced bone mass
- 25(OH)D testing for children/adolescents with recurrent low‑impact fractures
- 25(OH)D testing in children with multiple risk factors for vitamin D deficiency
- Pediatric BMI greater than or equal to 95th percentile for age (Z68.54)
2 Active Policies
AMBETTER-CP.MP.157 — 25-hydroxyvitamin D Testing in Children and Adolescents
AMBETTER-CP.MP.154 — Thyroid Hormones and Insulin Testing in Pediatrics
Related Codes
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