Does D59.13 require prior authorization?

No, D59.13 does not require prior authorization (high confidence). Covered without prior authorization.

`D59.13`, Mixed type autoimmune hemolytic anemia

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Claims must be supported by medical record documentation of the patient’s diagnosis/clinical condition and justification that the selected drug, dose, and route of administration are appropriate and medically necessary for the non-oncologic indication.
Billing must comply with Medicare rules and any applicable LCD prior authorization or documentation requirements; follow any specific forms or prior authorization processes required by the LCD or payer.
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.

Anti-neoplastic (chemotherapy) agent CPT/HCPCS codes may be used to bill for administration of these drugs when given to treat non-oncologic (noncancer) diagnoses if the drug is medically necessary for the patient’s condition and consistent with the standard of medical practice.
Monoclonal antibody agents and other biologic response modifiers may be administered and billed using chemotherapy administration codes for noncancer indications when the dose, route, and clinical use are appropriate and medically necessary.
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.
IVIG is covered only for indications specified as covered in the related Local Coverage Determination (LCD) and when medical necessity criteria in that LCD are met.
Off-label use of rituximab or rituximab biosimilars is allowable when the patient has documented lack of efficacy of prior treatments, including dosing, frequency, duration, and documentation of response(s).
Off-label use is allowable when first-line therapy produced an adverse reaction that absolutely contraindicates further use or causes non-transient side effects that impair functional capacity or activities of daily living, with the adverse event documented.

CGS-J15-L34037, Flow Cytometry

J15

CGS-J15-L35891, Intravenous Immune Globulin

J15

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

J15

CGS-J15-L38920, Off-label Use of Rituximab and Rituximab Biosimilars

J15

CGS-J18-L38249

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