Does D69.59 require prior authorization?

No, D69.59 does not require prior authorization (high confidence). Covered without prior authorization.

`D69.59`, Other secondary thrombocytopenia

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

For services requiring a referring/ordering physician, the claim must report the referring/ordering physician's name and NPI.
Claims must include a valid ICD-10-CM diagnosis code that best describes the patient's condition for which the genomic sequencing service was performed.
Documentation should support that the panel's biomarkers meet Medicare coverage criteria (for example, NCCN Biomarkers Compendium Evidence Category I or 2A) and demonstrate associated clinical utility.
Laboratories and clinicians including non‑NCCN genes in panels are advised to adhere to regulatory and institutional oversight mechanisms to document clinical validity and utility.

Targeted genomic sequence analysis panels for hematolymphoid neoplasms (including acute myelogenous leukemia, myelodysplastic syndromes, and myeloproliferative neoplasms) are covered when the panel contains at least 5 gene tests for molecular biomarkers that meet Medicare coverage criteria (for example, NCCN Biomarkers Compendium Evidence Category I or 2A) and are consistent with NCCN recommendations.
Targeted genomic sequence analysis panels with 5–50 genes (CPT 81450 or 81451) or 51 or more genes (CPT 81455 or 81456) are represented by these CPT codes and may be used when the panel meets the minimum 5-gene and evidence requirements above.
Minimal residual disease (MRD) testing in myelodysplastic syndromes (MDS) for single-gene tests may be covered when the test is medically reasonable and necessary for the individual patient's care.
IVIG is covered only for indications specified as covered in the related Local Coverage Determination (LCD) and when medical necessity criteria in that LCD are met.
Bill this policy's procedures when submitting claims for Next-Generation Sequencing (NGS) lab-developed tests (LDTs) for myeloid malignancies or suspected myeloid malignancies.
Off-label IVIG use may be billed when supported by the applicable Local Coverage Determination (LCD) and by documentation of medical necessity; off-label is defined as not in Medicare-approved compendia or the FDA label.

CGS-J15-L40225, MolDX: Non-Next Generation Sequencing Targeted Molecular Panel Tests for Predictive Testing in Cancer

J15

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

J15

CGS-J15-L34037, Flow Cytometry

J15

CGS-J18-L40225, MolDX: Non-Next Generation Sequencing Targeted Molecular Panel Tests for Predictive Testing in Cancer

J18

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