Z87.442 — Personal history of urinary calculi
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- ICD-10 R82.991 - R82.998 are listed as 'covered if selection criteria are met' — selection criteria are referenced but not detailed in the document.
- The policy does not list explicit documentation requirements (e.g., required clinical notes, lab results, prior therapies) for metabolic/environmental profiling or for imaging; no other specific documentation elements are specified in the CPB.
Key Coverage Criteria
- ICD-10 codes R82.991 - R82.998 (Other abnormal findings in urine) are listed as "ICD-10 codes covered if selection criteria are met" (selection criteria not specified in the CPB).
- ICD-10 codes R82.991 - R82.998 (Other abnormal findings in urine) covered if selection criteria are met
- Note: The policy does not state any metabolic or environmental profiling methods as covered for assessment of kidney stone risk; instead these are listed as experimental and investigational (see Limitations).
1 Active Policy
AETNA-CPB-0392 — Metabolic and Environmental Profiling and Imaging for Kidney Stone Risk
Related Codes
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