Does C93.12 require prior authorization?

No, C93.12 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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`C93.12`, Chronic myelomonocytic 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

For services requiring a referring/ordering physician, the claim must report the referring/ordering physician's name and NPI.
Claims must include a valid ICD-10-CM diagnosis code that best describes the patient's condition for which the genomic sequencing service was performed.
Documentation should support that the panel's biomarkers meet Medicare coverage criteria (for example, NCCN Biomarkers Compendium Evidence Category I or 2A) and demonstrate associated clinical utility.

Key Coverage Criteria

Targeted genomic sequence analysis panels for hematolymphoid neoplasms (including acute myelogenous leukemia, myelodysplastic syndromes, and myeloproliferative neoplasms) are covered when the panel contains at least 5 gene tests for molecular biomarkers that meet Medicare coverage criteria (for example, NCCN Biomarkers Compendium Evidence Category I or 2A) and are consistent with NCCN recommendations.
Targeted genomic sequence analysis panels with 5–50 genes (CPT 81450 or 81451) or 51 or more genes (CPT 81455 or 81456) are represented by these CPT codes and may be used when the panel meets the minimum 5-gene and evidence requirements above.
Minimal residual disease (MRD) testing in myelodysplastic syndromes (MDS) for single-gene tests may be covered when the test is medically reasonable and necessary for the individual patient's care.
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.
Bill this policy's procedures when submitting claims for Next-Generation Sequencing (NGS) lab-developed tests (LDTs) for myeloid malignancies or suspected myeloid malignancies.

20 Active Policies

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

J15

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

J15

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

J15

CGS-J15-L34037, Flow Cytometry

J15

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

J18

CGS-J18-L40225, MolDX: Non-Next Generation Sequencing Targeted Molecular Panel Tests for Predictive Testing in Cancer

J18

CGS-J18-L38070, MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies

J18

CGS-J18-L34037, Flow Cytometry

J18

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

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

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

WPS-J5-L38176, MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies

WPS-J5-L40277, MolDX: Non-Next Generation Sequencing Targeted Molecular Panel Tests for Predictive Testing in Cancer

A57878, Billing and Coding: MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies

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

NGS-J6-L40357, Molecular Pathology Procedures

A56793, Billing and Coding: Genomic Sequence Analysis Panels in the Treatment of Hematolymphoid Diseases

NGS-J6-L37606, Genomic Sequence Analysis Panels in the Treatment of Hematolymphoid Diseases

NGS-J6-L36850, Peripheral Nerve Blocks

A57452, Billing and Coding: Peripheral Nerve Blocks

`C93.12`, Chronic myelomonocytic leukemia, in relapse

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

C93.12, Chronic myelomonocytic leukemia, in relapse

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`C93.12`, Chronic myelomonocytic leukemia, in relapse