Does D81.4 require prior authorization?

No, D81.4 does not require prior authorization (high confidence). Covered without prior authorization.

`D81.4`, Nezelof's syndrome

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

All documentation must be maintained in the patient's medical record, be legible, include patient identification and dates of service, and include the legible signature of the responsible physician or non-physician practitioner.
The submitted medical record must support the selected ICD-10-CM code(s), the CPT/HCPCS code billed, and the medical necessity of the services as stated in the LCD/NCD.
Medical record information should include relevant diagnostic laboratory studies, prior history of bleeding or infection, disease progression, prior medical/surgical therapies, and vaccination response when relevant to establishing coverage indications.
An accurate weight in kilograms must be documented prior to infusion because immune globulin dosing is calculated in mg/kg.

Coverage requires documentation that the immune globulin therapy is reasonable and necessary in accordance with LCD L34007 and applicable NCDs.
Molecular syndromic infectious disease panels are covered when billed with the appropriate proprietary CPT® or PLA code and an accompanying ICD-10-CM diagnosis that documents medical necessity in the patient record.
FDA-cleared/approved molecular infectious disease tests performed consistent with their intended use are covered without a DEX Z-code when billed with an appropriate supporting ICD-10-CM code.
A panel is a single test (single unit of service UOS=1) and is covered as one service even if it reports multiple pathogens or targets.
Testing for additional organisms not included in a billed panel is covered when ordered in addition to the panel and supported by documentation in the medical record.
Expanded (>5 pathogen) respiratory (RP/PNP) and gastrointestinal (GI) panels are covered when either (a) performed at POS 19, 21, 22, or 23, or (b) ordered by an approved specialist per patient immune status and clinical indication (see documentation criteria).

CGS-J15-L39038, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

J15

CGS-J15-L34037, Flow Cytometry

J15

CGS-J15-L34200, Removal of Benign Skin Lesions

J15

CGS-J18-L34200, Removal of Benign Skin Lesions

J18

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