Z77.010 — Contact with and (suspected) exposure to arsenic
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- No specific documentation requirements, prior authorization, or required medical records/test results are specified in this policy bulletin.
- Note: External guidance cited (NICE 2007) recommends use only in research settings (controlled trials, closely observed case series and/or contribution to a register), which would imply research documentation if used in that context, but Aetna's CPB itself does not list documentation requirements.
Key Coverage Criteria
- None — Aetna considers Grenz ray therapy experimental and investigational for the treatment of dermatologic conditions because there is inadequate evidence in the published peer-reviewed medical literature regarding the effectiveness of Grenz ray therapy in the treatment of skin disorders.
- Chelation therapy is consideredmedically necessarytreatment for individuals with relevant clinical findings suggestive of heavy metal toxicity and a probable exposure history inanyof the following conditions when confirmed by laboratory testing*:
- Individuals with disorders of iron metabolism (for example, primary or secondary hemochromatosis);or
- Lead overload in cases of acute or long-term lead exposure;or
- Individuals with disorders of copper metabolism (for example, Wilsonâs disease);or
- Arsenic, mercury, iron, copper, or gold poisoning when long-term exposure and toxicity has been confirmed;or
2 Active Policies
AETNA-CPB-0231 — Grenz Ray Therapy for Skin Disorders
ANTHEM-CG-MED-90 — CG-MED-90 Chelation Therapy
Related Codes
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