Does C96.6 require prior authorization?

No, C96.6 does not require prior authorization (high confidence). Covered without prior authorization.

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`C96.6`, Unifocal Langerhans-cell histiocytosis

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Use CPT codes 78472, 78473, 78481, 78483, 78494, or 78496 when billing cardiac blood pool imaging (MUGA, ventriculography).
When applicable, include the additional secondary code indicating personal history of malignant neoplasm (Z85 series) per Correct Coding Initiative (CCI) guidelines alongside the appropriate C-code or D-code family entry.
Refer to the policy's Covered ICD-10 Codes section to select the appropriate C-code, D-code, and Z85 family codes for billing cardiac blood pool imaging.
This billing and coding article provides guidelines that complement Local Coverage Determination L34415 for CT of the abdomen and pelvis; consult LCD L34415 for specific coverage indications, limitations, and documentation requirements.

Key Coverage Criteria

Cardiac blood pool imaging (MUGA, ventriculography) is covered when performed for patients receiving cardiotoxic chemotherapy.
Cardiac blood pool imaging is covered for evaluation of valvular disease or cardiomyopathies.
Prior to initiation of cardiotoxic chemotherapy, bill cardiac blood pool imaging with ICD-10 code Z01.89 plus the appropriate C-code or D-code family entry.
During or for interval assessment while receiving cardiotoxic chemotherapy, bill using the appropriate T45.1X5* encounter code (T45.1X5A, T45.1X5D, or T45.1X5S) to indicate ongoing exposure.
At completion of cardiotoxic chemotherapy, bill cardiac blood pool imaging with ICD-10 code Z08 and the appropriate C-code or D-code family entry.
Therapeutic respiratory procedures (HCPCS G0237, G0238, G0239) using an individualized physical conditioning and exercise program with breathing techniques are covered for patients with documented activity limitations.

20 Active Policies

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

J15

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

J18

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

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

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A specific written order (referral/prescription) by the physician or appropriate NPP must be on file for all respiratory care services.

Medical records must fully document that services were reasonable and medically necessary, with results and usage of the test documented in the record and available upon request.

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

WPS-J5-L38213, Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF)

A57630, Billing and Coding: Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF)

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

WPS-J8-L38213, Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF)

WPS-J8-L38835, MolDX: Minimal Residual Disease Testing for Cancer

WPS-J8-L39040, MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer

A54768, Billing and Coding: Cardiac Blood Pool Imaging (Multiple Gated Acquisition Scanning- MUGA, Ventriculography) When Performed in Conjunction with Cardiotoxic Chemotherapy

A56421, Billing and Coding: CT of the Abdomen and Pelvis

A57224, Billing and Coding: Respiratory Care

A58998, Billing and Coding: MolDX: Minimal Residual Disease Testing for Hematologic Cancers

AMBETTER-CP.MP.242, Pulmonary Function Testing

A58679, Billing and Coding: MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer

A58988, Billing and Coding: MolDX: Minimal Residual Disease Testing for Hematologic Cancers

A58996, Billing and Coding: MolDX: Minimal Residual Disease Testing for Hematologic Cancers

A58652, Billing and Coding: MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer

C96.6, Unifocal Langerhans-cell histiocytosis