Prior Auth Required

21087 - service/diagnosis

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / Serviceservice/diagnosis
Procedure / Service Description

Service Category Benefit/Description Codes Requiring Authorization Member Program* - 53405, 53410, 53415, 58661, 58700, 58953, 58956, 15772, 15773, S9128, G0153 Gender affirming codes – not covered for diagnosis of Gender Dysphoria); may be covered for other 11950, 11951, 11952, 11954, 15780, 15781, 15782, 15783, 15786, 15787, 15788, 15789, 15792, 15793, 15824, 15826, 15828, All service/diagnosis 15829, 15876, 15877, 15878, 15879, 21087, 21120, 21121, 21122, 21123, 21125, 21127, 21270, 21899, 31899, 40799, 67900 Genetic Testing Genetic Testing – General (all tests) All genetic testing (incl. but not limited to CPT 81161+; categories below) All

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
  • Confirm the current plan policy before submission.
  • Use the insurer authorization workflow for this listed code.