Does D84.1 require prior authorization?

No, D84.1 does not require prior authorization (high confidence). Covered without prior authorization.

`D84.1`, Defects in the complement system

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Follow LCD L35434 for reasonable and necessary requirements and supporting medical documentation for oximetry services.
Report overnight oximetry using CPT code 94762 on claims.
Claims must include the appropriate CPT® or PLA code; if no proprietary CPT/PLA code exists, bill with the appropriate CPT® code or CPT® 87999 if no other CPT describes the service.
Tests billed with CPT® 87999 or tests without a proprietary CPT/PLA code require submission of a DEX Z-code identifier and a MolDX Technical Assessment (TA).

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).
Pre-transplant evaluation panels for immune-compromised beneficiaries are covered regardless of symptoms when clear pre-transplant documentation accompanies the claim.

CGS-J15-L34037, Flow Cytometry

J15

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

J15

CGS-J18-L34037, Flow Cytometry

J18

CGS-J18-L39038, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

J18

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