Does D09.9 require prior authorization?

No, D09.9 does not require prior authorization (high confidence). Covered without prior authorization.

`D09.9`, Carcinoma in situ, unspecified

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Maintain all documentation in the patient's medical record and make it available to the contractor upon request; every page must be legible and include patient identifiers (complete name, dates of service).
Medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
Documentation should state whether the block was performed for diagnostic or therapeutic purposes.

Peripheral nerve blocks are covered when they meet the reasonable and necessary requirements specified in LCD L33933.
Lab-developed tests for inherited cancer syndromes in patients with cancer (per LCD L38966) are covered when billed with the required claim elements specified in this policy.
Coverage applies for lab-developed tests (LDTs) for inherited cancer syndromes in patients with cancer when billed in accordance with MolDX LCD L38972.
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.
No covered indications are explicitly listed in this CPB. The bulletin primarily designates adoptive immunotherapy and cellular therapy approaches described below as experimental and investigational (i.e., not supported as effective).
Note / exception: "This policy does not apply to lifileucel for the treatment of advanced melanoma." (lifileucel is handled separately).

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

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

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

FIRST_COAST-L33933, Peripheral Nerve Blocks

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