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ICD-10-CM Z52.20, Bone donor, unspecified | No Prior Auth

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`Z52.20`, Bone donor, unspecified

ICD-10-CM

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Documentation Required

Documentation that the patient with advanced cancer meets the clinical indication for somatic genomic profiling (diagnosis/stage/clinical context).
Documentation that the provider informed the patient, prior to somatic testing, of the potential to uncover incidental germline findings.
Documentation that treatment decisions are based on clinically validated/actionable variants (not VUS) and, when applicable, results of confirmatory germline testing for suspected hereditary variants.
Submit an ICD-10 diagnosis code on the claim that corresponds to the panel indication (e.g., C34 for lung, C18-C20 for colorectal).

Key Coverage Criteria

Glioma — diagnosis or undergoing workup
Histiocytosis — diagnosis or undergoing workup
Sarcoma — diagnosis or undergoing workup
NPM1 (MRD) testing for myeloid leukemia monitoring (ICD: C92).
Gastrointestinal stromal tumor (GIST) when the tumor is negative for KIT and PDGFRA somatic mutations
Advanced (stage IIIb or higher) or metastatic squamous cell lung carcinoma

1 Active Policy

AMBETTER-CG-Onc-Tumor-Hemat.-Malig.-2025.1, Concert Genetic Oncology: Molecular Analysis of Solid Tumors and Hematologic Malignancies

Related Codes

0016U(1 policies)0017U(1 policies)0022U(1 policies)0023U(1 policies)0027U(1 policies)0036U(1 policies)0037U(1 policies)0001U(1 policies)

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Specify the exact panel/test name and performing laboratory on the requisition/claim.

Submit the ICD-10-CM diagnosis code that corresponds to the tumor type listed in the table with the test order.