Z82.79 — Family history of other congenital malformations, deformations and chromosomal abnormalities
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Reimbursement will only be provided if a requested service(s) is submitted in accordance with the relevant criteria outlined in the applicable Coverage Policy, including covered diagnosis and/or procedure code(s).
- When billing, providers must use the most appropriate codes as of the effective date of the submission (policy note).
- Claims submitted for services that are not accompanied by covered code(s) under the applicable Coverage Policy will be denied as not covered.
- Clinical documentation should support one of the covered indications listed in the policy (e.g., history/physical findings of neoplasm or mass, suspicious/enlarged lymph node, thyroid/parathyroid cancer or high-risk history, thyrotoxicosis, thyroid nodule, multinodular goiter, congenital primary hypothyroidism, primary hyperparathyroidism, hypercalcemia, salivary gland stone/infection, suspected/known foreign body, assessment for abscess).
Key Coverage Criteria
- Ultrasound of head and neck soft tissues is considered medically necessary for an individual with ANY of the following indications:
- neoplasm of the head or neck
- soft tissue mass of the head or neck
- enlarged lymph node that is suspicious for malignancy
- thyroid or parathyroid cancer
- thyroid cancer screening in high-risk individual (e.g., history of head and neck irradiation; positive family history of thyroid cancer in a first-degree relative or a thyroid cancer syndrome family history, such as familial polyposis, Carney complex, multiple endocrine neoplasia type 2, Werner syndrome, or Cowden syndrome).
5 Active Policies
AMBETTER-CG-Epilepsy-Neurodegen-Neuromusc-DO-2025.1 — Concert Genetic Testing: Epilepsy, Neurodegenerative, and Neuromuscular Conditions
AMBETTER-CG-Multi-Inher-DO.-Intel-Dis.-DD-2025.1 — Concert Genetic Testing: Multisystem Inherited Disorders, Intellectual Disability, and Developmental Delay
AMBETTER-CG-Skeletal-Dysplasias-2025.1 — Concert Genetic Testing: Skeletal Dysplasia and Rare Bone Disorders
CIGNA-0549 — Head and Neck Ultrasound - (0549)
Related Codes
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