Does C91.52 require prior authorization?

No, C91.52 does not require prior authorization (high confidence). Covered without prior authorization.

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`C91.52`, Adult T-cell lymphoma/leukemia (HTLV-1-associated), in relapse

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.
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).

20 Active Policies

CGS-J15-L34037, Flow Cytometry

J15

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

J15

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

J15

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

J15

CGS-J18-L34356

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A claim submitted without a valid ICD-10-CM diagnosis code will be returned as an incomplete claim under Section 1833(e) and the diagnosis code(s) must best describe the patient's condition for which the service was performed.

For diagnostic tests, report the test result if known; if not available, report the symptoms that prompted the test.

, Erythropoiesis Stimulating Agents (ESA)

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

J18

CGS-J18-L34037, Flow Cytometry

J18

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

J18

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

A59004, Billing and Coding: MolDX: Minimal Residual Disease Testing for Hematologic Cancers

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

WPS-J5-L39477, Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin's and Non-Hodgkin's Lymphoma with B-cell or T-cell Origin

A59259, Billing and Coding: Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin's and Non-Hodgkin's Lymphoma with B-cell or T-cell Origin

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

NGS-J6-L36850, Peripheral Nerve Blocks

NGS-J6-L40334, Erythropoiesis Stimulating Agents

A57452, Billing and Coding: Peripheral Nerve Blocks

NGS-J6-L40333, Erythropoiesis Stimulating Agents

NGS-J6-L39513, Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin and Non-Hodgkin Lymphoma with B-cell or T-cell Origin

A59311, Billing and Coding: Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin and Non-Hodgkin Lymphoma with B-cell or T-cell Origin

C91.52, Adult T-cell lymphoma/leukemia (HTLV-1-associated), in relapse