Does D69.0 require prior authorization?

No, D69.0 does not require prior authorization (high confidence). Covered without prior authorization.

`D69.0`, Allergic purpura

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.
Claims should reference and be supported by LCD L34580 and follow the billing/coding guidelines in this article; specific documentation requirements (e.g., medical records, prior authorization) are those detailed in LCD L34580.
For transplant rejection and GVHD indications: documentation that disease is refractory to standard immunosuppressive drug treatment (clear record of prior and/or concurrent standard therapies, doses, dates, and documented lack of adequate response or contraindication to standard therapy).

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.
Billing and coding for intravenous immunoglobulin (IVIG) should follow the Local Coverage Determination (LCD) L34580 and the billing/coding guidelines in this article as a complement to that LCD.
ICD-10 codes covered if selection criteria are met (as listed in the policy):
C84.00 - C84.09: Mycosis fungoides
C84.10 - C84.19: Sezary's disease

WPS-J5-L37205, Chemotherapy Drugs and their Adjuncts

A55639, Billing and Coding: Chemotherapy Agents for Non-Oncologic Conditions

WPS-J8-L37205, Chemotherapy Drugs and their Adjuncts

AETNA-CPB-0241, Extracorporeal Photochemotherapy (Photopheresis)

AETNA-CPB-0768

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