Does D48.60 require prior authorization?

No, D48.60 does not require prior authorization (high confidence). Code is covered without prior authorization.

`D48.60`, Neoplasm of uncertain behavior of unspecified breast

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Claims must report the appropriate CPT code for the flow cytometry service, include 1 unit of service (UOS), and list the appropriate ICD-10-CM diagnosis code.
Medical necessity documentation per LCD L34513 is required when coverage criteria are not fully met in this billing guideline (for example, when >24 markers are requested).
Claims must include the appropriate CPT code, 1 unit of service (UOS), and the appropriate ICD-10-CM diagnosis code.
Additional medical necessity documentation must be submitted when more than 24 markers are tested.

Coverage and medical necessity determinations for flow cytometry are governed by Local Coverage Determination L34513.
Flow cytometry may be used to analyze cellular components of body fluids and lymphoreticular tissues, including peripheral blood, cerebrospinal fluid (CSF), bone marrow, lymph nodes, tonsil, spleen, and fine needle aspirate material.
Peripheral blood or fine needle aspirate specimens may be used to avoid more invasive diagnostic procedures when clinically appropriate.
Flow cytometry is covered for examination of body fluids (including peripheral blood and cerebrospinal fluid), bone marrow, and lymphoreticular tissues (lymph nodes, tonsil, spleen).
Peripheral blood and fine needle aspirate specimens are acceptable for flow cytometry to avoid more invasive diagnostic procedures.
Coverage decisions are governed by the associated Local Coverage Determination LCD L34215 and its specific coverage criteria.

FIRST_COAST-L33933, Peripheral Nerve Blocks

ANTHEM-CG-DME-06, Compression Devices for Lymphedema

AETNA-CPB-0105, Magnetic Resonance Imaging (MRI) of the Breast

AETNA-CPB-0269, Breast Biopsy Procedures

AETNA-CPB-0717, Analysis of Volatile Organic Compounds

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