Does D82.9 require prior authorization?

No, D82.9 does not require prior authorization (high confidence). Code is covered without prior authorization.

`D82.9`, Immunodeficiency associated with major defect, unspecified

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

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.
The medical record must fully support medical necessity per the LCD, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
For diagnostic tests, report the test result on the claim if known; if the result is not known at submission, report the symptoms prompting the performance of the test.
When a specialist order permits billing outside specified POS, documentation of the specialist communication in the medical record is required.

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.
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).
An access-based exception may permit coverage for tests ordered by non-specialists outside the specified POS when the beneficiary cannot reasonably reach a specialist (e.g., rural or island locations) and the ordering provider is closer to the beneficiary; this must be documented.
Chronic granulomatous disease

NGS-J6-L39226, Multiplex Gastrointestinal Pathogen Panel (GPP) Tests for Acute Gastroenteritis (AGE)

A58963, Billing and Coding: Multiplex Gastrointestinal Pathogen Panel (GPP) Tests for Acute Gastroenteritis (AGE)

NGS-JK-L39226, Multiplex Gastrointestinal Pathogen Panel (GPP) Tests for Acute Gastroenteritis (AGE)

ANTHEM-MP-A047560, TRANS.00029 Hematopoietic Stem Cell Transplantation for Genetic Diseases and Aplastic Anemias

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