Does T86.819 require prior authorization?

No, T86.819 does not require prior authorization (high confidence). Covered without prior authorization.

`T86.819`, Unspecified complication of lung transplant

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

The submitted medical record must support the selected ICD-10-CM code(s), and the submitted CPT/HCPCS code must accurately describe the service performed.
The medical record must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
When billing CPT 84999 for the listed tests, include a note identifying the specific test in the Remarks (Part A) or Narrative (Part B) area of the claim.
All documentation must be maintained in the patient's medical record, be legible, include patient identification (e.g., complete name) and dates of service, and be made available to the contractor upon request.

For tests that currently lack specific CPT codes (functional intracellular analysis and total antioxidant function), bill using CPT 84999 and add a note identifying which test was performed in the Remarks area for Part A claims and the Narrative area for Part B claims.
Coverage and reasonable/necessary determinations for assays for vitamins and metabolic function are governed by LCD L34914 and claims must meet that LCD's requirements to be covered.
Flow cytometry is covered for examination of body fluids (including peripheral blood and cerebrospinal fluid), bone marrow, and lymphoreticular tissues (lymph nodes, tonsil, spleen).
Peripheral blood and fine needle aspirate specimens are acceptable for flow cytometry to avoid more invasive diagnostic procedures.
Coverage decisions are governed by the associated Local Coverage Determination LCD L34215 and its specific coverage criteria.
None specified. Aetna considers the analysis of volatile organic compounds experimental and investigational for the indications listed below (see Limitations).

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

J15

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

J15

CGS-J18-L40139, MolDX: Molecular Testing for Solid Organ Allograft Rejection

J18

CGS-J18-L40140, MolDX: Molecular Testing for Solid Organ Allograft Rejection

J18

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