Does C92.00 require prior authorization?

No, C92.00 does not require prior authorization (high confidence). Code is covered without prior authorization.

`C92.00`, Acute myeloblastic leukemia, not having achieved remission

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Use CPT 81120 to report Abbott RealTime IDH1 for claims dated on or after 2018-07-20 and CPT 81121 to report Abbott RealTime IDH2 for claims dated on or after 2018-01-01.
Enter 1 unit of service (UOS) per test on the claim.
Include the appropriate DEX Z‑Code™ identifier adjacent to the CPT code in the comment/narrative field for Part B claims (Loop 2400 or SV101-7 for 837P; Box 19 for paper claims).
Include the appropriate DEX Z‑Code™ identifier adjacent to the CPT code for Part A claims (Line SV202-7 for 837I electronic claims; Block 80 for UB04).

Abbott RealTime IDH1 (Abbott Molecular) is FDA‑approved to identify adult AML patients with a susceptible IDH1 mutation to aid selection of treatment with ivosidenib and is covered by Medicare effective 2018-07-20.
Abbott RealTime IDH2 (Abbott Molecular) is FDA‑approved to identify adult AML patients with a susceptible IDH2 mutation to aid selection of treatment with enasidenib and is covered by Medicare effective 2017-08-01.
Testing is indicated for adult patients with relapsed or refractory acute myeloid leukemia when a susceptible IDH1 or IDH2 mutation will inform use of the corresponding FDA‑approved targeted therapy.
Bill this policy's procedures when submitting claims for Next-Generation Sequencing (NGS) lab-developed tests (LDTs) for myeloid malignancies or suspected myeloid malignancies.
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).

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

J15

CGS-J15-L34037, Flow Cytometry

J15

CGS-J15-L38070, MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies

J15

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

J15

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