Does I82.599 require prior authorization?

No, I82.599 does not require prior authorization (high confidence). Covered without prior authorization.

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`I82.599`, Chronic embolism and thrombosis of other specified deep vein of unspecified lower extremity

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

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.

Medical record documentation of a VTE diagnosis (including site: e.g., cerebral or splanchnic) is required.

Documentation that the VTE is associated with non-surgical major transient or hormonal risk factors per ASH guidelines is required when coverage is based on those risk factors.

Key Coverage Criteria

Endoluminal radiofrequency ablationorendoluminal laser ablation:
The following modalities are consideredmedically necessarywhen the criteria below (I, II,andIII) have been met:
Ablative Modalities:Endoluminal radiofrequency;orEndoluminal laser;and
Endoluminal radiofrequency;or
Endoluminal laser;and
The veins to be treated include one or more of the following:Anterior accessory great saphenous vein (AAGSV) also known as anterior saphenous vein (ASV);orGreat saphenous vein (GSV);orSmall saphenous veins (SSV)and

5 Active Policies

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

ANTHEM-CG-SURG-119, Treatment of Varicose Veins (Lower Extremities)

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I82.599, Chronic embolism and thrombosis of other specified deep vein of unspecified lower extremity