Does D61.82 require prior authorization?

No, D61.82 does not require prior authorization (high confidence). Code is covered without prior authorization.

`D61.82`, Myelophthisis

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

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.
Follow the associated Local Coverage Determination LCD L34215 for full documentation and coverage requirements not detailed here.
Submit the appropriate CPT® or PLA code (or CPT® 87999 if no specific code) with each claim and ensure the CPT/HCPCS code describes the service performed.

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.
Molecular syndromic infectious disease panels are covered when billed with the appropriate proprietary CPT®/PLA code (or CPT® 87999 if no specific code exists) and accompanied by ICD-10-CM diagnosis codes that support medical necessity documented in the patient record.
FDA-approved or cleared molecular infectious disease tests performed consistent with their intended use labeling are covered without a DEX Z-Code and Technical Assessment when billed with appropriate ICD-10-CM diagnosis codes and supporting documentation.
Expanded (>5 pathogens) respiratory (RP/PNP) and gastrointestinal (GI) panels are covered if billed from place of service (POS) 19, 21, 22, or 23, or if ordered by an appropriate specialist depending on beneficiary immune status and the specialist is diagnosing/treating the beneficiary.

CGS-J15-L34037, Flow Cytometry

J15

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

J15

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

J15

CGS-J18-L34037, Flow Cytometry

J18

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