Z98.870 — Personal history of in utero procedure during pregnancy
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- No specific documentation requirements are stated in this CPB.
- The policy directs readers to check benefit plan descriptions for details regarding what constitutes treatment of illness or injury under a particular plan.
Key Coverage Criteria
- General coverage principle: Aetna medical benefit plans provide coverage only for treatment of illness or injury (check individual benefit plan descriptions for specific covered services).
- None specific for work hardening programs — Aetna does not cover work hardening programs when provided for occupational/return-to-work/reintegration or other vocational purposes, because these are considered vocational training and not treatment of illness or injury.
- Serum iron testing is consideredmedically necessaryfor any of the following indications:
- Evaluation of suspected iron deficiency in individuals who meet any of the following criteria:Abnormal blood counts consistent with iron deficiency including, but not limited to, the following:Decreased mean corpuscular volume (MCV);orDecreased hemoglobin/hematocrit when the MCV is low or normal;orIncreased red cell distribution width (RDW) and low or normal MCV;orEvidence of acute or chronic blood loss including, but not limited to, the following:Gastrointestinal blood loss;orHematuria;orMenorr [...]
- Abnormal blood counts consistent with iron deficiency including, but not limited to, the following:Decreased mean corpuscular volume (MCV);orDecreased hemoglobin/hematocrit when the MCV is low or normal;orIncreased red cell distribution width (RDW) and low or normal MCV;or
- Decreased mean corpuscular volume (MCV);or
2 Active Policies
AETNA-CPB-0198 — Work Hardening Programs
ANTHEM-CG-LAB-21 — CG-LAB-21 Serum Iron Testing
Related Codes
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