Does D55.9 require prior authorization?

No, D55.9 does not require prior authorization (high confidence). Covered without prior authorization.

`D55.9`, Anemia due to enzyme disorder, unspecified

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Claims should reference and be supported by LCD L34580 and follow the billing/coding guidelines in this article; specific documentation requirements (e.g., medical records, prior authorization) are those detailed in LCD L34580.
Select and report the appropriate CPT or PLA code for the blood product molecular antigen typing service and enter the unit of service (UOS) on the claim.
For Part B claims, enter the appropriate DEX Z-Code identifier adjacent to the CPT/PLA code in the comment/narrative field: use Loop 2400 or SV101-7 for 5010A1 837P electronic claims or Box 19 for paper claims.
For Part A claims, enter the appropriate DEX Z-Code identifier adjacent to the CPT/PLA code in the comment/narrative field: use Line SV202-7 for 837I electronic claims or Block 80 for the UB04 claim form.

Billing and coding for intravenous immunoglobulin (IVIG) should follow the Local Coverage Determination (LCD) L34580 and the billing/coding guidelines in this article as a complement to that LCD.
MolDX blood product molecular antigen typing panels 0001U and 0084U (germline tests) are covered for beneficiaries but are limited to one test per beneficiary lifetime.
Blood Product Molecular Antigen Typing is covered when ordered consistent with the applicable MolDX Local Coverage Determination (LCD) clinical indications.
Blood product molecular antigen typing panels 0001U and 0084U are covered as germline tests when billed consistent with MolDX LCD L38249.
Panel codes 0001U and 0084U for blood product molecular antigen typing are covered when billed as a panel.
Blood product molecular antigen typing services consistent with the Local Coverage Determination L38240 are eligible for coverage (clinical criteria per LCD L38240).

CGS-J15-L38249, MolDX: Blood Product Molecular Antigen Typing

J15

CGS-J18-L38249, MolDX: Blood Product Molecular Antigen Typing

J18

A57110, Billing and Coding: MolDX: Blood Product Molecular Antigen Typing

WPS-J5-L38441, MolDX: Blood Product Molecular Antigen Typing

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