Does D89.42 require prior authorization?

No, D89.42 does not require prior authorization (high confidence). Code is covered without prior authorization.

`D89.42`, Idiopathic mast cell activation syndrome

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
Every page of the medical record must be legible and include patient identification information (e.g., complete name, dates of service).
The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing care to the patient.
The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.

A GIP multiplex NAAT panel (CPT 87505, 87506, 87507) may be reported when medically reasonable and necessary per Local Coverage Determination (LCD) L38227.
Gastrointestinal pathogen (GIP) multiplex NAAT panels (CPT 87505, 87506, 87507) are covered when reasonable and necessary in accordance with LCD L38229.
Flow cytometry is covered for examination of body fluids (including peripheral blood and cerebrospinal fluid), bone marrow, and lymphoreticular tissues (lymph nodes, tonsil, spleen).
Peripheral blood and fine needle aspirate specimens are acceptable for flow cytometry to avoid more invasive diagnostic procedures.
Coverage decisions are governed by the associated Local Coverage Determination LCD L34215 and its specific coverage criteria.
Respiratory pathogen panel testing is covered when performed in an outpatient, non-institutional Part B setting from a single biologic specimen on a single date of service and the order is not a reflex test.

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

J15

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

J18

WPS-J5-L39044, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

A58761, Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

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