Does C40.82 require prior authorization?

No, C40.82 does not require prior authorization (high confidence). Code is covered without prior authorization.

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`C40.82`, Malignant neoplasm of overlapping sites of bone and articular cartilage of left limb

ICD-10-CM

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Documentation Required

The provider/supplier must notify the beneficiary in writing, prior to rendering the service, if the provider/supplier is aware the test may not be covered by Medicare.
A pathologist performing additional tests must document why additional testing was done in the report and confirm that the results were communicated to and used by the treating physician/practitioner in the beneficiary's treatment.
Non-physician practitioners (e.g., nurse practitioners, clinical nurse specialists, physician assistants) may certify, order, and establish the plan of care for flow cytometry services as authorized by State law.

For FQHC services with dates of service on or after April 1, 2010, bill type 77X should be used to report flow cytometry services.

Document Hgb and/or Hct values to support initiation and maintenance of ESA therapy (including Hgb immediately prior to initiation for chemotherapy patients).

Before starting ESA therapy, consider, document, and correct reversible causes of anemia: iron deficiency, infection/inflammation, hematologic disease, hemolysis, vitamin deficiencies (folate/B12), blood loss, and aluminum intoxication.

Key Coverage Criteria

Flow cytometry is covered to detect antigens used as therapeutic targets in neoplastic disease.
Flow cytometry is covered for diagnosis and classification of hematopoietic neoplasms.
Flow cytometry is covered to assess biologic parameters associated with prognosis in hematopoietic neoplasms.
Flow cytometry is covered to detect residual neoplastic cells following therapy (minimal residual disease detection).
Flow cytometry is covered to monitor lymphocyte populations in patients with HIV infection.
Flow cytometry is covered to monitor lymphocyte subpopulations in post-transplant patients on immunosuppressive therapy.

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CGS-J15-L38822, MolDX: Minimal Residual Disease Testing for Cancer

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CGS-J15-L38067, MolDX: Next-Generation Sequencing for Solid Tumors

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CGS-J15-L34037, Flow Cytometry

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CGS-J15-L38065, MolDX: Plasma-Based Genomic Profiling in Solid Tumors

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CGS-J15-L40386, Erythropoiesis Stimulating Agents (ESA)

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CGS-J18-L38067, MolDX: Next-Generation Sequencing for Solid Tumors

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CGS-J18-L38065, MolDX: Plasma-Based Genomic Profiling in Solid Tumors

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CGS-J18-L36658, Proton Beam Therapy

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CGS-J18-L34356, Erythropoiesis Stimulating Agents (ESA)

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CGS-J18-L40225, MolDX: Non-Next Generation Sequencing Targeted Molecular Panel Tests for Predictive Testing in Cancer

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CGS-J18-L38822, MolDX: Minimal Residual Disease Testing for Cancer

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CGS-J18-L34037, Flow Cytometry

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CGS-J18-L40386, Erythropoiesis Stimulating Agents (ESA)

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WPS-J5-L38168, MolDX: Plasma-Based Genomic Profiling in Solid Tumors

WPS-J5-L38158, MolDX: Next-Generation Sequencing for Solid Tumors

WPS-J5-L38835, MolDX: Minimal Residual Disease Testing for Cancer

WPS-J5-L39040, MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer

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C40.82, Malignant neoplasm of overlapping sites of bone and articular cartilage of left limb