Does D48.2 require prior authorization?

No, D48.2 does not require prior authorization (high confidence). Covered without prior authorization.

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`D48.2`, Neoplasm of uncertain behavior of peripheral nerves and autonomic nervous system

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

The patient's medical record must contain documentation that fully supports medical necessity, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Each claim must be submitted with ICD-10-CM codes that reflect the patient's condition and the reason for the service; claims without ICD-10-CM codes will be returned.
For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.

A permanent record of the ultrasound and its interpretation must be kept in the patient's record, including images labeled with exam date, patient identification, and image orientation; documentation of variations from normal with measurements; and a formal interpretation.

Key Coverage Criteria

Nonvascular extremity ultrasound is covered when medical necessity is documented in the patient's record, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Diagnostic nonvascular extremity ultrasound is covered when the claim includes an ICD-10-CM diagnosis code that best describes the patient's condition and the test result or the symptoms prompting the test are documented.
CPT codes 64400-64530 for peripheral nerve blocks may be reported on the date of surgery when performed for postoperative pain management only if the operative anesthesia is general anesthesia, subarachnoid injection, or epidural injection and the adequacy of intraoperative anesthesia is not dependent on the peripheral nerve block.
Peripheral nerve block services that are separate, medically necessary services which cannot be rendered by the surgeon may be reported if the surgeon documents the reason for referral and the additional services are justified in the medical record.
Flow cytometry is covered to detect antigens used as therapeutic targets in neoplastic disease.
Flow cytometry is covered for diagnosis and classification of hematopoietic neoplasms.

20 Active Policies

CGS-J15-L34037, Flow Cytometry

J15

CGS-J15-L34195, Mohs Micrographic Surgery

J15

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

J15

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

J15

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

J18

CGS-J18-L34037, Flow Cytometry

J18

CGS-J18-L34195, Mohs Micrographic Surgery

J18

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

J18

A56787, Billing and Coding: Nonvascular Extremity Ultrasound

NGS-J6-L33619, Nonvascular Extremity Ultrasound

NGS-J6-L36850, Peripheral Nerve Blocks

NGS-J6-L40333, Erythropoiesis Stimulating Agents

NGS-J6-L40334, Erythropoiesis Stimulating Agents

A57452, Billing and Coding: Peripheral Nerve Blocks

FIRST_COAST-L33933, Peripheral Nerve Blocks

NOVITAS-JH-L35396, Biomarkers for Oncology

NGS-JK-L33619, Nonvascular Extremity Ultrasound

NGS-JK-L40333, Erythropoiesis Stimulating Agents

NGS-JK-L36850, Peripheral Nerve Blocks

NGS-JK-L40334, Erythropoiesis Stimulating Agents

`D48.2`, Neoplasm of uncertain behavior of peripheral nerves and autonomic nervous system

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

D48.2, Neoplasm of uncertain behavior of peripheral nerves and autonomic nervous system

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`D48.2`, Neoplasm of uncertain behavior of peripheral nerves and autonomic nervous system