Does N03.A require prior authorization?

No, N03.A does not require prior authorization (high confidence). Covered without prior authorization.

`N03.A`, Chronic nephritic syndrome with C3 glomerulonephritis

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Refer to Local Coverage Determination L35026 for clinical coverage criteria, medical necessity requirements, and any required prior authorization; this article complements that LCD with billing/coding guidance.

Renal transplant recipients who are ABO compatible who are experiencing antibody mediated rejection (AMR) or require desensitization (living donor)
Wilsonâs disease - fulminant
Renal transplant recipients who are ABO incompatible and require desensitization (living donor)
Plasmapheresis or plasma exchange is consideredmedically necessaryfor any of the following conditions listed in alphabetical order below:Acute inflammatory demyelinating polyradiculoneuropathy / Guillain-Barre syndromeAnti-glomerular basement membrane disease (Goodpasture's syndrome) when the individual is dialysis-independent or there is evidence of diffuse alveolar hemorrhage (DAH)Atypical hemolytic uremic syndrome (aHUS) with Factor H autoantibodies or complement gene mutationAutoimmune hemol [...]
Acute inflammatory demyelinating polyradiculoneuropathy / Guillain-Barre syndrome
Anti-glomerular basement membrane disease (Goodpasture's syndrome) when the individual is dialysis-independent or there is evidence of diffuse alveolar hemorrhage (DAH)

ANTHEM-CG-MED-68, Therapeutic Apheresis

ANTHEM-CG-DME-41, Ultraviolet Light Therapy Delivery Devices for Home Use

A56380, Billing and Coding: Rituximab

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