Does D47.02 require prior authorization?

No, D47.02 does not require prior authorization (high confidence). Code is covered without prior authorization.

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`D47.02`, Systemic mastocytosis

ICD-10-CM

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Documentation Required

Enter the appropriate CPT code that corresponds to the NGS LDT being billed.
Include the appropriate DEX Z-Code identifier adjacent to the CPT code in the comment/narrative field for the specified claim fields.
For Part B electronic claims (837P), place the DEX Z-Code in Loop 2400 or SV101-7; for Part B paper claims place it in Box 19.
For Part A electronic claims (837I), place the DEX Z-Code in Line SV202-7; for UB04 paper claims place it in Block 80.

Key Coverage Criteria

Bill this policy's procedures when submitting claims for Next-Generation Sequencing (NGS) lab-developed tests (LDTs) for myeloid malignancies or suspected myeloid malignancies.
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.
ClonoSeq (NGS-based MRD test) is covered for patients with acute lymphoblastic leukemia (ALL).
ClonoSeq (NGS-based MRD test) is covered for patients with multiple myeloma (MM).
ClonoSeq (NGS-based MRD test) is covered for patients with chronic lymphocytic leukemia (CLL).
ClonoSeq (NGS-based MRD test) is covered for patients with diffuse large B-cell lymphoma (DLBCL).

20 Active Policies

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

J15

CGS-J15-L34356, Erythropoiesis Stimulating Agents (ESA)

J15

CGS-J15-L40386, Erythropoiesis Stimulating Agents (ESA)

J15

CGS-J15-L34037, Flow Cytometry

J15

CGS-J15-L38070

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Select and report the appropriate ICD-10-CM diagnosis code that corresponds to the myeloid malignancy or suspected myeloid malignancy being tested.

Report the appropriate CPT code for the test being performed.

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

CGS-J18-L34356, Erythropoiesis Stimulating Agents (ESA)

J18

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

J18

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

J18

CGS-J18-L34037, Flow Cytometry

J18

CGS-J18-L40386, Erythropoiesis Stimulating Agents (ESA)

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

WPS-J5-L39040, MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with 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-L40334, Erythropoiesis Stimulating Agents

NGS-J6-L40333, Erythropoiesis Stimulating Agents

NGS-J6-L36850, Peripheral Nerve Blocks

NGS-J6-L35000, Molecular Pathology Procedures

D47.02, Systemic mastocytosis