Z79.4 — Long term (current) use of insulin
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- The patient's medical record must contain documentation that fully supports the medical necessity for the visual fields testing in accordance with the applicable LCD.
- Documentation should include relevant medical history, a physical examination, and results of pertinent diagnostic tests or procedures supporting the need for visual fields testing.
- The diagnosis code(s) reported on the claim must best describe the patient's condition for which the visual fields testing was performed.
- Refer to NCCI and OPPS requirements prior to billing Medicare to ensure coding compliance and to determine any bundling or packaging edits.
Key Coverage Criteria
- ICD-10-CM Codes that Support Medical Necessity — Group 1 (covered diagnoses): D56.1 - Beta thalassemia
- ICD-10-CM Codes that Support Medical Necessity — Group 1 (covered diagnoses): D57.02 - Hb-SS disease with splenic sequestration
- ICD-10-CM Codes that Support Medical Necessity — Group 1 (covered diagnoses): D57.1 - Sickle-cell disease without crisis
- ICD-10-CM Codes that Support Medical Necessity — Group 1 (covered diagnoses): D57.212 - Sickle-cell/Hb-C disease with splenic sequestration
- ICD-10-CM Codes that Support Medical Necessity — Group 1 (covered diagnoses): D57.412 - Sickle-cell thalassemia, unspecified, with splenic sequestration
- ICD-10-CM Codes that Support Medical Necessity — Group 1 (covered diagnoses): D57.812 - Other sickle-cell disorders with splenic sequestration
20 Active Policies
L40271 — MolDX: Biomarker Testing for Risk Stratification in Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis
J05
A60305 — Billing and Coding: MolDX: Biomarker Testing for Risk Stratification in Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis
J05
A57736 — Billing and Coding: Vitamin D Assay Testing
J06
A56551 — Billing and Coding: Visual Fields Testing
J06
Related Codes
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