Does C79.49 require prior authorization?

No, C79.49 does not require prior authorization (high confidence). Code is covered without prior authorization.

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`C79.49`, Secondary malignant neoplasm of other parts of nervous system

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.

20 Active Policies

CGS-J15-L36021, MolDX: Molecular Diagnostic Tests (MDT)

J15

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

J15

CGS-J15-L36658, Proton Beam Therapy

J15

CGS-J15-L34399, Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)

J15

CGS-J15-L34394, Visual Fields Testing

J15

CGS-J15-L35906, Somatosensory Testing

J15

CGS-J15-L34037, Flow Cytometry

J15

CGS-J15-L38584, MolDX: Phenotypic Biomarker Detection from Circulating Tumor Cells

J15

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

J15

CGS-J15-L35442, MolDX: NRAS Genetic Testing

J15

CGS-J15-L35897, Nerve Conduction Studies and Electromyography

J15

CGS-J18-L35906, Somatosensory Testing

J18

CGS-J18-L36021, MolDX: Molecular Diagnostic Tests (MDT)

J18

CGS-J18-L34394, Visual Fields Testing

J18

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

J18

CGS-J18-L34037, Flow Cytometry

J18

CGS-J18-L34399, Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)

J18

CGS-J18-L35442, MolDX: NRAS Genetic Testing

J18

CGS-J18-L35897, Nerve Conduction Studies and Electromyography

J18

CGS-J18-L36658, Proton Beam Therapy

J18

Have a follow-up question?

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

Ask Backwork about C79.49 Sign up free

C79.49, Secondary malignant neoplasm of other parts of nervous system

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.

20 Active Policies

CGS-J15-L36021, MolDX: Molecular Diagnostic Tests (MDT)

J15

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

J15

CGS-J15-L36658, Proton Beam Therapy

J15

CGS-J15-L34399, Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)

J15

CGS-J15-L34394, Visual Fields Testing

J15

CGS-J15-L35906, Somatosensory Testing

J15

CGS-J15-L34037, Flow Cytometry

J15

CGS-J15-L38584, MolDX: Phenotypic Biomarker Detection from Circulating Tumor Cells

J15

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

J15

CGS-J15-L35442, MolDX: NRAS Genetic Testing

J15

CGS-J15-L35897, Nerve Conduction Studies and Electromyography

J15

CGS-J18-L35906, Somatosensory Testing

J18

CGS-J18-L36021, MolDX: Molecular Diagnostic Tests (MDT)

J18

CGS-J18-L34394, Visual Fields Testing

J18

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

J18

CGS-J18-L34037, Flow Cytometry

J18

CGS-J18-L34399, Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)

J18

CGS-J18-L35442, MolDX: NRAS Genetic Testing

J18

CGS-J18-L35897, Nerve Conduction Studies and Electromyography

J18

CGS-J18-L36658, Proton Beam Therapy

J18

Have a follow-up question?

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

Ask Backwork about C79.49 Sign up free

`C79.49`, Secondary malignant neoplasm of other parts of nervous system

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`C79.49`, Secondary malignant neoplasm of other parts of nervous system

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

C79.49, Secondary malignant neoplasm of other parts of nervous system

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

C79.49, Secondary malignant neoplasm of other parts of nervous system

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`C79.49`, Secondary malignant neoplasm of other parts of nervous system

`C79.49`, Secondary malignant neoplasm of other parts of nervous system