Does D80.7 require prior authorization?

No, D80.7 does not require prior authorization (high confidence). Covered without prior authorization.

`D80.7`, Transient hypogammaglobulinemia of infancy

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

All documentation must be maintained in the patient medical record and made available to the contractor upon request, with every page legible and including patient identification (complete name, dates of service).
The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
The submitted medical record must support the use of the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
Results of the vitamin D testing and the resulting treatment regimen must be documented in the patient's medical record, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures (e.g., progress notes and written laboratory reports).

25-hydroxy vitamin D testing (including fractions, if performed) is covered when deemed reasonable and necessary per Local Coverage Determination L33771.
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.
Coverage requires documentation that the immune globulin therapy is reasonable and necessary in accordance with LCD L34007 and applicable NCDs.
When billed outside the specified POS, the test is covered if ordered by a diagnosing/treating specialist in Infectious Diseases, Gastroenterology, Oncology, or Transplant, with specialist communication documented in the medical record.
Multiplex GPP tests for diagnosis of acute gastroenteritis (AGE) are covered when billed in POS 20, 21, 22, 23, or 81.
Multiplex GPP tests are covered when ordered as part of a pre-transplant evaluation for an immunocompromised beneficiary and billed in POS 81 (Independent Laboratory).

CGS-J15-L35891, Intravenous Immune Globulin

J15

CGS-J15-L34037, Flow Cytometry

J15

CGS-J15-L34200, Removal of Benign Skin Lesions

J15

CGS-J18-L34037, Flow Cytometry

J18

CGS-J18-L34200, Removal of Benign Skin Lesions

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