Does C91.42 require prior authorization?

No, C91.42 does not require prior authorization (high confidence). Covered without prior authorization.

`C91.42`, Hairy cell leukemia, in relapse

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Report BRAF V600 test kit services using CPT code 81210 on claims.
Submit the assigned DEX Z-Code™ Identifier in the comment/narrative field: Loop 2400 or SV101-7 for 5010A1 837P electronic claims; alternatively use SV202-7 (preferred) or the NTE field.
For paper Part B claims attach the DEX Z-Code identifier to the claim; for Part A enter the DEX Z-Code adjacent to CPT on Line SV202-7 for 837I electronic claims or Block 80 on the UB-04 form.
Select and report the appropriate ICD-10-CM diagnosis code for melanoma on the claim.

BRAF V600 mutation testing (cobas® 4800 BRAF V600) is covered to detect BRAF mutation in melanoma to determine eligibility for vemurafenib (Zelboraf) in patients with melanoma that is unresectable or metastatic.
BRAF V600E and V600K mutation testing (ThxID™ BRAF V600/K) is covered to identify melanoma patients whose tumors carry V600E and/or V600K mutations for selection of dabrafenib (Tafinlar) and/or trametinib (Mekinist).
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.
ClonoSeq (NGS-based MRD test) is covered for patients with acute lymphoblastic leukemia (ALL).
ClonoSeq (NGS-based MRD test) is covered for patients with multiple myeloma (MM).
ClonoSeq (NGS-based MRD test) is covered for patients with chronic lymphocytic leukemia (CLL).

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

J15

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

J15

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

J15

CGS-J15-L34037, Flow Cytometry

J15

CGS-J15-L36021

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