Does D61.818 require prior authorization?

No, D61.818 does not require prior authorization (high confidence). Covered without prior authorization.

`D61.818`, Other pancytopenia

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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.

Bill this policy's procedures when submitting claims for Next-Generation Sequencing (NGS) lab-developed tests (LDTs) for myeloid malignancies or suspected myeloid malignancies.
Molecular syndromic infectious disease panels are covered when billed with the appropriate proprietary CPT® or PLA code and an accompanying ICD-10-CM diagnosis that documents medical necessity in the patient record.
FDA-cleared/approved molecular infectious disease tests performed consistent with their intended use are covered without a DEX Z-code when billed with an appropriate supporting ICD-10-CM code.
A panel is a single test (single unit of service UOS=1) and is covered as one service even if it reports multiple pathogens or targets.
Testing for additional organisms not included in a billed panel is covered when ordered in addition to the panel and supported by documentation in the medical record.
Expanded (>5 pathogen) respiratory (RP/PNP) and gastrointestinal (GI) panels are covered when either (a) performed at POS 19, 21, 22, or 23, or (b) ordered by an approved specialist per patient immune status and clinical indication (see documentation criteria).

CGS-J15-L39038, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

J15

CGS-J15-L38070, MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies

J15

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

J15

CGS-J15-L34037, Flow Cytometry

J15

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