Does Z85.6 require prior authorization?

No, Z85.6 does not require prior authorization (high confidence). Covered without prior authorization.

`Z85.6`, Personal history of leukemia

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Report the appropriate CPT code for the test being performed.
Enter 1 unit of service (UOS) for the reported CPT code.
Include the appropriate DEX Z-Code identifier adjacent to the CPT code in the comment/narrative field for Part B electronic claims (Loop 2400 or SV101-7 for 5010A1 837P) and paper claims (Box 19).
Include the appropriate DEX Z-Code identifier adjacent to the CPT code in the comment/narrative field for Part A electronic claims (Line SV202-7 for 837I) and UB04 claims (Block 80).

Lab-developed tests for inherited cancer syndromes in patients with cancer as described in Local Coverage Determination (LCD) L39040 are the services addressed by this billing/coding guidance.
Germline pharmacogenomic (PGx) testing is covered when the test results have established clinical utility to guide management of a specific drug therapy for the Medicare beneficiary.
CPT 81418 (drug metabolism genomic sequence analysis panel) is covered when the panel tests at least 6 genes and includes CYP2C19, CYP2D6, and CYP2D6 duplication/deletion analysis.
A single-gene or single-allele test ordered by a treating clinician is covered even if the laboratory operationally assays additional genes on the same platform, provided coverage is limited to the single gene/allele component that was reasonable and necessary.
Germline testing that includes genetic content previously untested in the same beneficiary may be covered if the remaining, non-duplicative components demonstrate established clinical utility.
ClonoSeq (NGS-based MRD test) is covered for patients with acute lymphoblastic leukemia (ALL).

CGS-J15-L34037, Flow Cytometry

J15

CGS-J15-L38822, MolDX: Minimal Residual Disease Testing for Cancer

J15

CGS-J18-L34037, Flow Cytometry

J18

CGS-J18-L38822, MolDX: Minimal Residual Disease Testing for Cancer

J18

WPS-J5-L38835

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