Does B15.0 require prior authorization?

No, B15.0 does not require prior authorization (high confidence). Covered without prior authorization.

`B15.0`, Hepatitis A with hepatic coma

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

This billing and coding article provides guidelines that complement Local Coverage Determination L34415 for CT of the abdomen and pelvis; consult LCD L34415 for specific coverage indications, limitations, and documentation requirements.
For Rho(D) immune globulin (Rhogam): documentation of maternal Rh(D) status (unsensitized Rh-negative), paternal Rh status if known, timing (24–28 weeks and postpartum within 72 hours if indicated), and obstetric events prompting administration.
For transplant CMV prophylaxis with Cytogam: documentation of transplant type, timing relative to transplant (eg, within 72 hours), dosing schedule adherence and serostatus where relevant (noting that many renal transplant studies limited to CMV sero-negative recipients).
For infant botulism Big-IV: documentation of suspected/confirmed infant botulism, toxin type where available, and timing of administration (earlier associated with improved outcomes).

Continuation of therapy: Aetna considers continuation of therapy medically necessary for all members (including new members) who meet all initial medical necessity criteria for the respective immune globulin products (hepatitis B IG, CMV IG, Rho-D IG, rabies IG, VZIG, tetanus IG, vaccinia IG, BIG-IV, IGIM (GamaSTAN)).
GamaSTAN (intramuscular immune globulin): prophylaxis following exposure to hepatitis A (greatest benefit when given before or soon after exposure).
GamaSTAN: prevention or modification of measles (rubeola) in a susceptible person exposed fewer than 6 days previously (including susceptible household contacts, particularly contacts under 1 year of age; also indicated for pregnant women without evidence of immunity).
GamaSTAN: may modify varicella when Varicella Zoster Immune Globulin is unavailable (passive immunization) for immunosuppressed patients.
GamaSTAN: to modify rubella in exposed women who will not consider therapeutic abortion.
Cytomegalovirus immune globulin (Cytogam, IV): prophylaxis of CMV disease in kidney, heart, lung, pancreas and liver transplant patients.

ANTHEM-CG-LAB-21, Serum Iron Testing

ANTHEM-CG-LAB-29, Gamma Glutamyl Transferase Testing

AETNA-CPB-0544, Immune Globulins for Post-Exposure Prophylaxis

A56421, Billing and Coding: CT of the Abdomen and Pelvis

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