Does C72.59 require prior authorization?

No, C72.59 does not require prior authorization (high confidence). Code is covered without prior authorization.

Backwork Sign up free

`C72.59`, Malignant neoplasm of other cranial nerves

ICD-10-CM

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Documentation Required

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.
For patients who may need iron supplementation during ESA therapy, document iron stores with transferrin saturation > 20% and/or serum ferritin > 100 ng/mL to guide supplementation.
For MDS patients document pretreatment erythropoietin level (≤ 500) and blast percentage (< 10%) prior to ESA initiation.
Documentation must be available upon request to justify any practice of maintaining Hgb/Hct above the LCD target ranges for rare comorbid conditions.
Claims must reflect proper modifiers (EA, EC, EB) and appropriate diagnosis codes; specific combinations (per CMS) will result in denial when exclusions apply (see limitations).

Key Coverage Criteria

ESA therapy is covered to treat clinically significant anemia by elevating or maintaining red blood cell levels (as demonstrated by Hgb/Hct) to decrease anemia and reduce the need for transfusions.
End stage renal disease (ESRD) patients on dialysis with anemia (Hgb < 10.0 g/dL or Hct < 30%) are eligible for ESA therapy.
Chronic kidney disease (not on dialysis) patients with anemia (Hgb < 10.0 g/dL or Hct < 30%) and evidence of marked renal dysfunction (serum creatinine >= 3 mg/dL OR creatinine clearance < 60 mL/min OR GFR < 60 mL/min/1.73 m2) are eligible for ESA therapy.
Patients with non-myeloid malignancies who have anemia due to concomitant myelosuppressive chemotherapy are eligible for ESA therapy when the hemoglobin immediately prior to initiation or maintenance is < 10.0 g/dL (Hct < 30%).
Patients with anemia due to AZT and/or other nucleoside reverse transcriptase inhibitors (NRTIs) for HIV/AIDS with Hgb < 10.0 g/dL or Hct < 30% at initiation are eligible for ESA therapy.
Selected patients with myelodysplastic syndromes (MDS) with < 10% blasts, pretreatment erythropoietin level ≤ 500 (units as per lab), and anemia (Hgb < 10.0 g/dL or Hct < 30%) are eligible for ESA therapy.

20 Active Policies

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

J15

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

J15

CGS-J15-L35897, Nerve Conduction Studies and Electromyography

J15

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

J15

CGS-J15-L34394, Visual Fields Testing

J15

CGS-J15-L36658, Proton Beam Therapy

J15

CGS-J15-L35906, Somatosensory Testing

J15

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

J15

CGS-J15-L34356, Erythropoiesis Stimulating Agents (ESA)

J15

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

J15

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

J18

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

J18

CGS-J18-L35906, Somatosensory Testing

J18

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

J18

CGS-J18-L34394, Visual Fields Testing

J18

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

J18

CGS-J18-L36658, Proton Beam Therapy

J18

CGS-J18-L35897, Nerve Conduction Studies and Electromyography

J18

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

J18

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

J18

Have a follow-up question?

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

Ask Backwork about C72.59 Sign up free

C72.59, Malignant neoplasm of other cranial nerves

ICD-10-CM

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Documentation Required

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.
For patients who may need iron supplementation during ESA therapy, document iron stores with transferrin saturation > 20% and/or serum ferritin > 100 ng/mL to guide supplementation.
For MDS patients document pretreatment erythropoietin level (≤ 500) and blast percentage (< 10%) prior to ESA initiation.
Documentation must be available upon request to justify any practice of maintaining Hgb/Hct above the LCD target ranges for rare comorbid conditions.
Claims must reflect proper modifiers (EA, EC, EB) and appropriate diagnosis codes; specific combinations (per CMS) will result in denial when exclusions apply (see limitations).

Key Coverage Criteria

ESA therapy is covered to treat clinically significant anemia by elevating or maintaining red blood cell levels (as demonstrated by Hgb/Hct) to decrease anemia and reduce the need for transfusions.
End stage renal disease (ESRD) patients on dialysis with anemia (Hgb < 10.0 g/dL or Hct < 30%) are eligible for ESA therapy.
Chronic kidney disease (not on dialysis) patients with anemia (Hgb < 10.0 g/dL or Hct < 30%) and evidence of marked renal dysfunction (serum creatinine >= 3 mg/dL OR creatinine clearance < 60 mL/min OR GFR < 60 mL/min/1.73 m2) are eligible for ESA therapy.
Patients with non-myeloid malignancies who have anemia due to concomitant myelosuppressive chemotherapy are eligible for ESA therapy when the hemoglobin immediately prior to initiation or maintenance is < 10.0 g/dL (Hct < 30%).
Patients with anemia due to AZT and/or other nucleoside reverse transcriptase inhibitors (NRTIs) for HIV/AIDS with Hgb < 10.0 g/dL or Hct < 30% at initiation are eligible for ESA therapy.
Selected patients with myelodysplastic syndromes (MDS) with < 10% blasts, pretreatment erythropoietin level ≤ 500 (units as per lab), and anemia (Hgb < 10.0 g/dL or Hct < 30%) are eligible for ESA therapy.

20 Active Policies

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

J15

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

J15

CGS-J15-L35897, Nerve Conduction Studies and Electromyography

J15

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

J15

CGS-J15-L34394, Visual Fields Testing

J15

CGS-J15-L36658, Proton Beam Therapy

J15

CGS-J15-L35906, Somatosensory Testing

J15

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

J15

CGS-J15-L34356, Erythropoiesis Stimulating Agents (ESA)

J15

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

J15

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

J18

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

J18

CGS-J18-L35906, Somatosensory Testing

J18

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

J18

CGS-J18-L34394, Visual Fields Testing

J18

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

J18

CGS-J18-L36658, Proton Beam Therapy

J18

CGS-J18-L35897, Nerve Conduction Studies and Electromyography

J18

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

J18

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

J18

Have a follow-up question?

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

Ask Backwork about C72.59 Sign up free

`C72.59`, Malignant neoplasm of other cranial nerves

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`C72.59`, Malignant neoplasm of other cranial nerves

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

C72.59, Malignant neoplasm of other cranial nerves

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

C72.59, Malignant neoplasm of other cranial nerves

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`C72.59`, Malignant neoplasm of other cranial nerves

`C72.59`, Malignant neoplasm of other cranial nerves