Does C94.32 require prior authorization?

No, C94.32 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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`C94.32`, Mast cell 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

Providers must maintain patient weight in kilograms, ESA units administered per kilogram, and medical justification for any ESA doses exceeding usual doses.
The medical record must include the ordering provider's assessment related to the visit complaint, relevant medical history, results of pertinent tests/procedures, and a signed and dated office visit record or operative report.
For all patients receiving ESAs the medical record must document hemoglobin (Hgb) or hematocrit (Hct) and evidence of adequate iron stores.
Dialysis patient records must include dialysis schedule and Hgb/Hct immediately prior to the billing period; home dialysis patients additionally must have a care plan, evidence of home monitoring (including records of ESA supplied and doses administered), patient instructions, and patient selection protocol.

Key Coverage Criteria

Administration of erythropoiesis stimulating agents (ESAs) billed with HCPCS J0881, J0882, J0885, J0886, Q4081, Q5105, or Q5106 for patients with anemia related to ESRD, chronic kidney disease (CKD), chemotherapy, radiation, or myelodysplastic syndrome (MDS), when the use meets the coverage criteria in the applicable LCD.
Use of ESAs for chemotherapy-induced, radiation-induced, or non-chemo/non-radiation anemia should be identified on non-ESRD claims by reporting modifier EA (chemo-induced), EB (radio-induced), or EC (non-chemo/radio).
ESA administration may qualify as a Home Health service only when the beneficiary is receiving the ESA for a covered indication specified in the LCD.
CPT 88182 reports the physician professional and facility technical components of DNA ploidy and S-phase analysis of tumor by flow cytometry.
CPT 88184 (first marker) and CPT 88185 (each additional marker) report the facility technical component of flow cytometric immunophenotyping for assessment of potential hematolymphoid neoplasia.
Flow cytometry interpretation is reported using CPT codes 88187–88189 (one interpretation code per specimen).

20 Active Policies

CGS-J15-L34037, Flow Cytometry

J15

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

J15

CGS-J18-L34037, Flow Cytometry

J18

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

J18

A59004

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C94.32, Mast cell leukemia, in relapse