Does B19.11 require prior authorization?

No, B19.11 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

Backwork Sign up free

`B19.11`, Unspecified viral hepatitis B with hepatic coma

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Documentation Required

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.
Medical records must document the indication(s) supporting use of IVIG for each claim.
For indications where routine IVIG use is not indicated, the medical record must document prior interventions that were unsuccessful or reasons those interventions were not tolerated.

Key Coverage Criteria

IVIG is covered only for indications specified as covered in the related Local Coverage Determination (LCD) and when medical necessity criteria in that LCD are met.
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)

8 Active Policies

WPS-J5-L34771, Immune Globulins

A57554, Billing and Coding: Immune Globulins

WPS-J8-L34771, Immune Globulins

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

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

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

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

ANTHEM-LAB.00019, Proprietary Algorithms for Liver Fibrosis

`B19.11`, Unspecified viral hepatitis B with hepatic coma

Prior Authorization

Documentation Required

Key Coverage Criteria

8 Active Policies

Related Codes

Have a follow-up question?

B19.11, Unspecified viral hepatitis B with hepatic coma

Prior Authorization

Documentation Required

Key Coverage Criteria

8 Active Policies

Related Codes

Have a follow-up question?

`B19.11`, Unspecified viral hepatitis B with hepatic coma