Does C92.02 require prior authorization?

No, C92.02 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

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`C92.02`, Acute myeloblastic leukemia, in relapse

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Documentation Required

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).

Key Coverage Criteria

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).

20 Active Policies

CGS-J15-L34037, Flow Cytometry

J15

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

J15

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

J15

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

J15

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C92.02, Acute myeloblastic leukemia, in relapse