Does I82.539 require prior authorization?

No, I82.539 does not require prior authorization (high confidence). Covered without prior authorization.

`I82.539`, Chronic embolism and thrombosis of unspecified popliteal vein

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Document the VTE diagnosis and the associated risk factor(s) per ASH definitions, or document cerebral/splanchnic thrombosis and the clinical rationale that testing will inform long-term anticoagulation decisions.
Document that the genetic test result is expected to guide clinical management (for example influence anticoagulation duration).
Provide documentation of the test's genetic content and evidence that it includes the ASH-recommended minimum genes/variants and that those variants are detectable by the specific test; for single-variant testing, document the known familial variant.
Provide proof of satisfactory completion of the MolDX Technical Assessment for the specific test performed.

Genetic testing for hereditary thrombophilia is covered when the patient has venous thromboembolism (VTE) and the VTE is associated with non-surgical major transient or hormonal risk factors as defined by American Society of Hematology (ASH).
Genetic testing for hereditary thrombophilia is covered when the patient presents with cerebral or splanchnic venous thrombosis in a clinical setting where short-term primary anticoagulation is standard and testing will inform the decision for long-term anticoagulation.
Genetic testing is covered only when the results are expected to directly guide VTE clinical management (for example, influence the duration of anticoagulation).
The test performed must include at least the minimum genetic content (genes or variants) with definitive or well-established guidelines-based evidence as determined by ASH and the variants must be reasonably detectable by the test for its intended clinical use.
A single-variant test is covered if that variant is a known familial variant and it is the only variant considered reasonable and necessary for the patient.
The test is covered only if it has satisfactorily completed a Technical Assessment (TA) by the MolDX Molecular Diagnostic Services Program.

CGS-J15-L40258, MolDX: Genetic Testing for Hereditary Thrombophilia

J15

CGS-J18-L40258, MolDX: Genetic Testing for Hereditary Thrombophilia

J18

WPS-J5-L40273, MolDX: Genetic Testing for Hereditary Thrombophilia

WPS-J8-L40273, MolDX: Genetic Testing for Hereditary Thrombophilia

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