Does M33.90 require prior authorization?

No, M33.90 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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`M33.90`, Dermatopolymyositis, unspecified, organ involvement unspecified

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

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

Key Coverage Criteria

25-hydroxy vitamin D testing (including fractions, if performed) is covered when deemed reasonable and necessary per Local Coverage Determination L33771.
IVIG is covered only for indications specified as covered in the related Local Coverage Determination (LCD) and when medical necessity criteria in that LCD are met.
Erythrocyte sedimentation rate (ESR) testing is covered only when reasonable and necessary as defined by Local Coverage Determination L34021.
ESR performed for rheumatoid arthritis patients to assess the need for medication adjustments should be billed with a diagnosis code that reflects the specific antirheumatic medication the patient is receiving.
Use ICD-10 codes T39.4X5A–T39.4X5S for ESR billing when the patient with rheumatoid arthritis is receiving antirheumatics such as gold salts for medication evaluation.
Use ICD-10 codes T45.1X5A–T45.1X5S for ESR billing when the patient with rheumatoid arthritis is receiving antineoplastic or immunosuppressive drugs such as methotrexate for medication evaluation.

20 Active Policies

A57554, Billing and Coding: Immune Globulins

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

WPS-J5-L34771, Immune Globulins

A57668, Billing and Coding: Nerve Conduction Studies and Electromyography

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

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

NGS-J6-L35098, Nerve Conduction Studies and Electromyography

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

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

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

WPS-J8-L34771, Immune Globulins

A57657, Billing and Coding: Sedimentation Rate, Erythrocyte

FIRST_COAST-L33771, Vitamin D; 25 hydroxy, includes fraction(s), if performed

FIRST_COAST-L34021, Sedimentation Rate, Erythrocyte

A59764, Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound

A56841, Billing and Coding: Vitamin D; 25 hydroxy, includes fraction(s), if performed

NOVITAS-JH-L34914, Assays for Vitamins and Metabolic Function

NGS-JK-L35098, Nerve Conduction Studies and Electromyography

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

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

`M33.90`, Dermatopolymyositis, unspecified, organ involvement unspecified

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

M33.90, Dermatopolymyositis, unspecified, organ involvement unspecified

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`M33.90`, Dermatopolymyositis, unspecified, organ involvement unspecified