Does D63.1 require prior authorization?

No, D63.1 does not require prior authorization (high confidence). Covered without prior authorization.

`D63.1`, Anemia in chronic kidney disease

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

The submitted medical record must support the selected ICD-10-CM code(s), and the submitted CPT/HCPCS code must accurately describe the service performed.
The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
When billing CPT 84999 for the listed tests, include a note identifying the specific test in the Remarks (Part A) or Narrative (Part B) area of the claim.
All documentation must be maintained in the patient's medical record, be legible, include patient identification (e.g., complete name) and dates of service, and be made available to the contractor upon request.

For tests that currently lack specific CPT codes (functional intracellular analysis and total antioxidant function), bill using CPT 84999 and add a note identifying which test was performed in the Remarks area for Part A claims and the Narrative area for Part B claims.
Coverage and reasonable/necessary determinations for assays for vitamins and metabolic function are governed by LCD L34914 and claims must meet that LCD's requirements to be covered.
Administration of erythropoiesis stimulating agents (ESAs) billed with HCPCS J0881, J0882, J0885, J0886, Q4081, Q5105, or Q5106 for patients with anemia related to ESRD, chronic kidney disease (CKD), chemotherapy, radiation, or myelodysplastic syndrome (MDS), when the use meets the coverage criteria in the applicable LCD.
Use of ESAs for chemotherapy-induced, radiation-induced, or non-chemo/non-radiation anemia should be identified on non-ESRD claims by reporting modifier EA (chemo-induced), EB (radio-induced), or EC (non-chemo/radio).
ESA administration may qualify as a Home Health service only when the beneficiary is receiving the ESA for a covered indication specified in the LCD.
ESA therapy is indicated for anemia due to decreased erythropoietin production or relative erythropoietin resistance, e.g., anemia of chronic renal failure or end-stage renal disease (ESRD).

CGS-J15-L34356, Erythropoiesis Stimulating Agents (ESA)

J15

CGS-J15-L40386, Erythropoiesis Stimulating Agents (ESA)

J15

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

J15

CGS-J18-L40386, Erythropoiesis Stimulating Agents (ESA)

J18

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