Does B16.0 require prior authorization?

No, B16.0 does not require prior authorization (low confidence). No active coverage policies found for this code.

`B16.0`, Acute hepatitis B with delta-agent with hepatic coma

ICD-10-CM

No Prior Auth Required

No active coverage policies found for this code (low 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 HUS and ITP: documentation of clinical evidence of serious bleeding and measured platelet counts demonstrating either <50,000 or risk/potential for serious bleeding with platelet count <20,000 (lab results and clinical notes).
For ITP: documentation of prior management and rationale for ECI (e.g., prior therapies tried, splenectomy status if relevant) and that ECI is indicated given severity and platelet thresholds.
For SLE: documentation that disease is life‑threatening or severe and that conventional therapies have failed, become intolerable, or are contraindicated (treatment history, reason for failure/intolerance, clinical course).

ICD-10 D59.3: Hemolytic-uremic syndrome [with clinical evidence of serious bleeding with platelet count below 50,000 or the potential for serious bleeding with platelet count below 20,000] (covered if selection criteria are met)
ICD-10 D69.3: Immune thrombocytopenic purpura [idiopathic thrombocytopenic purpura (ITP) with clinical evidence of serious bleeding with platelet count below 50,000 or the potential for serious bleeding with platelet count below 20,000] (covered if selection criteria are met)
ICD-10 G70.01: Myasthenia gravis with (acute) exacerbation (covered if selection criteria are met)
ICD-10 L10.0 - L10.9: Pemphigus [resistant to standard therapy, including dapsone, corticosteroids, and immunosuppressants (e.g., azathioprine or cyclosporine)] (covered if selection criteria are met)
ICD-10 M05.00 - M06.9: Rheumatoid arthritis with rheumatoid factor [moderate to severe rheumatoid arthritis (RA), for reduction of signs and symptoms in members who have failed other treatments (e.g., NSAIDS, methotrexate)] (covered if selection criteria are met)
ICD-10 M32.10 - M32.9: Systemic lupus erythematosus (SLE) [severe for whom other interventions have been unsuccessful, have become intolerable, or are contraindicated] (covered if selection criteria are met)

ANTHEM-LAB.00019, Proprietary Algorithms for Liver Fibrosis

ANTHEM-CG-LAB-26, Outpatient Alpha-Fetoprotein Testing

AETNA-CPB-0355, Extracorporeal Immunoadsorption (Prosorba Column)

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

AETNA-CPB-0650, Polymerase Chain Reaction Testing: Selected Indications

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