Does D09.0 require prior authorization?

No, D09.0 does not require prior authorization (high confidence). Covered without prior authorization.

`D09.0`, Carcinoma in situ of bladder

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

When reporting the JW modifier for discarded drug, the medical record must clearly show the amount administered and the amount wasted.
Medical record must document prior anthracycline therapy for patients receiving albumin-bound paclitaxel, or clearly document a clinical contraindication to anthracycline therapy.
For claims with no discarded amounts from single-dose containers or single-use packages, include the JZ modifier as evidence on the claim (effective July 1, 2023).
Document dose and frequency as consistent with the FDA label or recognized compendia for the indication (including citations to the compendia if used for off-label indications).

Paclitaxel administered intravenously is covered for antineoplastic (cancer) indications when used in accordance with the FDA-approved labeling.
Off-label uses of paclitaxel are covered when supported by recognized compendia (e.g., NCCN, AHFS, Clinical Pharmacology, Lexi-Drugs, Micromedex) and dosing/frequency follow those compendia.
Albumin-bound paclitaxel (Abraxane) is covered when prior therapy included an anthracycline unless anthracycline therapy is clinically contraindicated.
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.
Report UroVysion Bladder Kit services using CPT 88120 or 88121 when ordered for a patient with an established diagnosis of cancer or a substantiated suspicion of cancer and when test results will directly impact patient management.
The ordering clinician must be the clinician responsible for the management of the patient’s cancer or substantiated suspicion of cancer at the time the test is ordered.

CGS-J15-L36975, Bladder/Urothelial Tumor Markers

J15

CGS-J18-L36975, Bladder/Urothelial Tumor Markers

J18

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

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

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