Does D68.59 require prior authorization?

No, D68.59 does not require prior authorization (high confidence). Covered without prior authorization.

`D68.59`, Other primary thrombophilia

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Policy content not provided; unable to determine required documentation, prior authorization, or forms for AICC claims—manual review of the full policy required.
The referring physician/nonphysician practitioner must state the clinical indication/medical necessity in the order for the test and provide the order to the performing provider.
The medical record must include a permanent report describing studies performed, any contrast or radiopharmaceuticals used, known significant reactions/complications, and comparisons with prior relevant studies.
Reports must document both normal and abnormal findings, measurements for variations from normal, and explicitly address the clinical question or explain why it cannot be answered.

Policy content not provided; unable to determine covered indications for AICC NCD 110.3—manual review of the full policy required.
Non-invasive peripheral venous and hemodialysis access studies are covered when the results will be used to guide the clinical management of the patient.
Duplex scanning and physiologic studies may be performed and reimbursed during the same encounter when physiologic studies are abnormal or when evaluating vascular trauma, thromboembolic events, or aneurysmal disease.
One preoperative scan for hemodialysis access site surgery is covered to plan access creation.
Pre-surgical radial artery conduit mapping may be accompanied by vein mapping only when arterial studies show an unacceptable conduit or insufficient arterial conduit is available for multiple bypass procedures.
Flow cytometry is considered medically necessary for the evaluation of any of the following: Hematopoietic/hematologic cancers; Immunodeficiency disorders, including human immunodeficiency virus (HIV) and acquired immunodeficiency virus syndrome (AIDS); Paroxysmal nocturnal hemoglobinuria; Gestational trophoblastic disease; Transplantation.

WPS-J5-L35751, Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies

A57594, Billing and Coding: Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies

WPS-J8-L35751, Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies

AMBETTER-CG-Hema-Cond-(nonCA)--2025.1, Concert Genetic Testing: Hematologic Conditions (non-cancerous)

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