Does C49.10 require prior authorization?

No, C49.10 does not require prior authorization (high confidence). Covered without prior authorization.

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`C49.10`, Malignant neoplasm of connective and soft tissue of unspecified upper limb, including shoulder

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

The intravitreal injection procedure must be coded using CPT code 67028 and the appropriate RT, LT, or 50 site modifier must be appended to indicate unilateral or bilateral service.
Dose and frequency for bevacizumab and biosimilars must follow the FDA label or recognized compendia for off-label uses; compendia cited include AHFS, Clinical Pharmacology, Lexi-Drugs, Micromedex DrugDex, NCCN, FDA, and USP.
When billing for metastatic (secondary) disease, use the code for the primary malignancy if the primary tumor is still present, and use the appropriate personal history 'Z' code if the primary malignancy is no longer present.

Key Coverage Criteria

For non-ophthalmologic (systemic) use, bevacizumab must be reported with HCPCS code J9035 (injection, bevacizumab, 10 mg) with units reflecting multiples of 10 mg provided.
For non-ophthalmologic use, bevacizumab-awwb (MVASI) must be reported with HCPCS code Q5107 (10 mg).
For non-ophthalmologic use, bevacizumab-bvzr (ZIRABEV) must be reported with HCPCS code Q5118 (10 mg).
Bevacizumab-maly (ALYMSYS/ALYMSYS1) is reported with HCPCS code C9142 for 10/01/2022–12/31/2022 and with HCPCS code Q5126 effective 01/01/2023 (10 mg).
Bevacizumab-adcd (Vegzelma) should be reported with HCPCS code Q5129 effective 04/01/2023.
For the period 09/27/2022 through 03/31/2023 bevacizumab-maly could be reported with miscellaneous code J3590 (per guidance for that timeframe).

20 Active Policies

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

J15

CGS-J15-L40225, MolDX: Non-Next Generation Sequencing Targeted Molecular Panel Tests for Predictive Testing in Cancer

J15

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

J15

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

J15

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

J18

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

J18

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

J18

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

J18

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

A58468, Billing and Coding: MolDX: Minimal Residual Disease Testing for Solid Tumor Cancers

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

A57858, Billing and Coding: MolDX: Next-Generation Sequencing for Solid Tumors

WPS-J5-L40277, MolDX: Non-Next Generation Sequencing Targeted Molecular Panel Tests for Predictive Testing in Cancer

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

A58756, Billing and Coding: MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer

A52370, Billing and Coding: Bevacizumab and biosimilars

NGS-J6-L37810, Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms

A56867, Billing and Coding: Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms

NGS-J6-L33394, Drugs and Biologicals, Coverage of, for Label and Off-Label Uses

A52450, Billing and Coding: Paclitaxel (e.g., Taxol/Abraxane )

`C49.10`, Malignant neoplasm of connective and soft tissue of unspecified upper limb, including shoulder

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

C49.10, Malignant neoplasm of connective and soft tissue of unspecified upper limb, including shoulder

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`C49.10`, Malignant neoplasm of connective and soft tissue of unspecified upper limb, including shoulder