Does A31.8 require prior authorization?

No, A31.8 does not require prior authorization (high confidence). Covered without prior authorization.

`A31.8`, Other mycobacterial infections

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

This billing/coding guideline complements LCD L33459 (Computerized Axial Tomography (CT), Thorax); follow the LCD for clinical coverage and any required documentation or prior authorization rules.
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).
Claims submitted for services that are not accompanied by covered code(s) under the applicable Coverage Policy will be denied as not covered.
When billing, providers must use the most appropriate codes as of the effective date of the submission.

Flow cytometry is considered medically necessary for the evaluation of any of the following: Hematopoietic/hematologic cancers; Immunodeficiency disorders, including human immunodeficiency virus (HIV) and acquired immunodeficiency virus syndrome (AIDS); Paroxysmal nocturnal hemoglobinuria; Gestational trophoblastic disease; Transplantation.
Diagnosis and/or evaluation of hematopoietic cancers, including lymphomas and leukemia, plasma cell neoplasms, myelodysplastic syndromes, myeloproliferative neoplasms, and certain anemias (as described in General Background).
Monitoring lymphocyte populations (e.g., T-cells, NK cells), including CD4 and CD8 counts and CD4/CD8 ratio for management of HIV disease (eligibility for antiretroviral therapy, monitoring immune restoration, guiding treatment against opportunistic infections).
Detection of minimal residual disease and detection of antigens used as therapeutic drug targets for cancer therapy (hematologic malignancies).
Diagnosis of paroxysmal nocturnal hemoglobinuria (PNH) — flow cytometry is considered the gold standard for identifying peripheral blood cells missing GPI-anchored proteins.
Assessment of DNA ploidy in gestational trophoblastic disease, including molar pregnancies.

CIGNA-0538, Flow Cytometry

A56580, Billing and Coding: Computerized Axial Tomography (CT), Thorax

Ask Backwork about documentation requirements, denial risks, or coverage in your state.