Does M33.11 require prior authorization?

No, M33.11 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

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`M33.11`, Other dermatomyositis with respiratory involvement

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Documentation Required

Claims must be supported by medical record documentation of the patient’s diagnosis/clinical condition and justification that the selected drug, dose, and route of administration are appropriate and medically necessary for the non-oncologic indication.
Billing must comply with Medicare rules and any applicable LCD prior authorization or documentation requirements; follow any specific forms or prior authorization processes required by the LCD or payer.
A clinical history from the referral source indicating the need for testing must be available in the medical record and retrievable for review.

Key Coverage Criteria

Anti-neoplastic (chemotherapy) agent CPT/HCPCS codes may be used to bill for administration of these drugs when given to treat non-oncologic (noncancer) diagnoses if the drug is medically necessary for the patient’s condition and consistent with the standard of medical practice.
Monoclonal antibody agents and other biologic response modifiers may be administered and billed using chemotherapy administration codes for noncancer indications when the dose, route, and clinical use are appropriate and medically necessary.
Electrodiagnostic testing (EMG and/or nerve conduction studies) is indicated for evaluation of suspected carpal tunnel syndrome.
EMG and/or nerve conduction studies are indicated for evaluation of suspected radiculopathy.
EMG and/or nerve conduction studies are indicated for evaluation of suspected mononeuropathy (single-nerve entrapment or injury).
EMG and/or nerve conduction studies are indicated for evaluation of suspected polyneuropathy or mononeuropathy multiplex.

20 Active Policies

CGS-J15-L35891, Intravenous Immune Globulin

J15

CGS-J15-L35897, Nerve Conduction Studies and Electromyography

J15

CGS-J18-L35897, Nerve Conduction Studies and Electromyography

J18

CGS-J18-L35891, Intravenous Immune Globulin

J18

A55639, Billing and Coding: Chemotherapy Agents for Non-Oncologic Conditions

WPS-J5-L34658, Vitamin D Assay Testing

WPS-J5-L34771, Immune Globulins

A57484, Billing and Coding: Vitamin D Assay Testing

A57554, Billing and Coding: Immune Globulins

A57478, Billing and Coding: Nerve Conduction Studies and Electromyography

WPS-J5-L37205, Chemotherapy Drugs and their Adjuncts

WPS-J5-L34594, Nerve Conduction Studies and Electromyography

A59434, Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

NGS-J6-L35098, Nerve Conduction Studies and Electromyography

A59101, Billing and Coding: Off-label Use of Rituximab and Rituximab Biosimilars

NGS-J6-L39314, Off-Label Use of Intravenous Immune Globulin (IVIG)

A57668, Billing and Coding: Nerve Conduction Studies and Electromyography

NGS-J6-L39297, Off-label Use of Rituximab and Rituximab Biosimilars

A58893, Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

A59105, Billing and Coding: Off-Label Use of Intravenous Immune Globulin (IVIG)

`M33.11`, Other dermatomyositis with respiratory involvement

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

M33.11, Other dermatomyositis with respiratory involvement

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`M33.11`, Other dermatomyositis with respiratory involvement