Does C84.77 require prior authorization?

No, C84.77 does not require prior authorization (high confidence). Covered without prior authorization.

Backwork Sign up free

`C84.77`, Anaplastic large cell lymphoma, ALK-negative, spleen

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

The performing provider must maintain medical record documentation that clearly supports the medical necessity of the billed service and include that documentation in the patient's record for review upon request.
Documentation should state whether the block was diagnostic or therapeutic, include pre- and post-procedure evaluations, and document patient education and the assessment of procedural outcome.
Documentation must support coverage criteria in the LCD 'Indications and Limitations of Coverage and/or Medical Necessity' section and the provider should document why services cannot be rendered by the surgeon when applicable.
For services requiring a referring/ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.

Key Coverage Criteria

CPT codes 64400-64530 for peripheral nerve blocks may be reported on the date of surgery when performed for postoperative pain management only if the operative anesthesia is general anesthesia, subarachnoid injection, or epidural injection and the adequacy of intraoperative anesthesia is not dependent on the peripheral nerve block.
Peripheral nerve block services that are separate, medically necessary services which cannot be rendered by the surgeon may be reported if the surgeon documents the reason for referral and the additional services are justified in the medical record.
Lab-developed tests for inherited cancer syndromes in patients with cancer as described in Local Coverage Determination (LCD) L39040 are the services addressed by this billing/coding guidance.
Off-label use of rituximab or rituximab biosimilars is allowable when the patient has documented lack of efficacy of prior treatments, including dosing, frequency, duration, and documentation of response(s).
Off-label use is allowable when first-line therapy produced an adverse reaction that absolutely contraindicates further use or causes non-transient side effects that impair functional capacity or activities of daily living, with the adverse event documented.
Off-label use is allowable for refractory disease when documentation includes all first-line treatment(s) with dosing, frequency, duration, and documentation of response(s).

20 Active Policies

CGS-J15-L39434, Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin's and Non-Hodgkin's Lymphoma with B-cell or T-cell Origin

J15

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

J15

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

J15

CGS-J15-L34037, Flow Cytometry

J15

Have a follow-up question?

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

Ask Backwork about C84.77 Sign up free

C84.77, Anaplastic large cell lymphoma, ALK-negative, spleen