Does T86.810 require prior authorization?

No, T86.810 does not require prior authorization (high confidence). Covered without prior authorization.

`T86.810`, Lung transplant rejection

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.
Select and report the appropriate CPT code for the test on the claim.
Enter 1 unit of service (UOS) for the test on the claim line.

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.
Molecular testing for detection or monitoring of solid organ allograft rejection is covered when the patient and clinical situation meet the coverage criteria of the referenced MolDx LCD/policy.
AlloMap (CareDx) gene expression profile performed on blood is covered for surveillance/assessment of heart transplant rejection when coverage criteria are met.
AlloSure (CareDx) targeted NGS measuring percent donor-derived cell-free DNA from blood is covered for assessment of kidney, heart, and lung transplant injury/rejection when coverage criteria are met.
AlloCare (CareDx) AlloSure Heart plus AlloMap Heart performed on the same blood sample is covered for heart transplant assessment when coverage criteria are met.

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

J15

CGS-J15-L38920, Off-label Use of Rituximab and Rituximab Biosimilars

J15

CGS-J15-L34037, Flow Cytometry

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.