Does P61.0 require prior authorization?

No, P61.0 does not require prior authorization (high confidence). Covered without prior authorization.

`P61.0`, Transient neonatal thrombocytopenia

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Medical records must document the indication(s) supporting use of IVIG for each claim.
For indications where routine IVIG use is not indicated, the medical record must document prior interventions that were unsuccessful or reasons those interventions were not tolerated.
Documentation must support objective clinical response to IVIG for continued coverage.
Medical records must be made available to the Contractor upon request to substantiate coverage and payment.

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.
CPT codes covered if selection criteria are met: 59001 (Amniocentesis; therapeutic amniotic fluid reduction (includes ultrasound guidance))
In utero fetal surgery for ablation of anastomotic vessels in acardiac twins
In utero fetal surgery for insertion of pleuro-amniotic shunt for fetal pleural effusion
In utero fetal surgery for laser ablation or occlusion of anastomotic vessels in early, severe (stages II to IV) twin-twin transfusion syndrome (see Appendix for staging classification)
In utero fetal surgery for removal of sacrococcygeal teratoma

WPS-J5-L34771, Immune Globulins

A57554, Billing and Coding: Immune Globulins

WPS-J8-L34771, Immune Globulins

AETNA-CPB-0449, Fetal Surgery In Utero

AETNA-CPB-0768, Romiplostim (Nplate)

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