Does T86.19 require prior authorization?

No, T86.19 does not require prior authorization (high confidence). Covered without prior authorization.

`T86.19`, Other complication of kidney transplant

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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.
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.

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.
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.
Flow cytometry is covered to detect antigens used as therapeutic targets in neoplastic disease.
Flow cytometry is covered for diagnosis and classification of hematopoietic neoplasms.
Flow cytometry is covered to assess biologic parameters associated with prognosis in hematopoietic neoplasms.

CGS-J15-L35891, Intravenous Immune Globulin

J15

CGS-J15-L38582, MolDX: Molecular Testing for Solid Organ Allograft Rejection

J15

CGS-J15-L40139, MolDX: Molecular Testing for Solid Organ Allograft Rejection

J15

CGS-J15-L40140, MolDX: Molecular Testing for Solid Organ Allograft Rejection

J15

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