Does Z85.72 require prior authorization?

No, Z85.72 does not require prior authorization (high confidence). Code is covered without prior authorization.

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`Z85.72`, Personal history of non-Hodgkin lymphomas

ICD-10-CM

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Documentation Required

This billing and coding article provides guidelines that complement Local Coverage Determination L34415 for CT of the abdomen and pelvis; consult LCD L34415 for specific coverage indications, limitations, and documentation requirements.
For services requiring a referring/ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.
Diagnostic test claims should include the test result if known; if result is not available, report the symptoms that prompted the test.
The patient's medical record must include the ordering provider's assessment related to the visit complaint, relevant medical history, results of pertinent tests/procedures, and a signed and dated office visit record or operative report.

Key Coverage Criteria

CPT 88182 reports the physician professional and facility technical components of DNA ploidy and S-phase analysis of tumor by flow cytometry.
CPT 88184 (first marker) and CPT 88185 (each additional marker) report the facility technical component of flow cytometric immunophenotyping for assessment of potential hematolymphoid neoplasia.
Flow cytometry interpretation is reported using CPT codes 88187–88189 (one interpretation code per specimen).
Quantitative cell counts by flow cytometry are billed using CPT codes 86355, 86356, 86357, 86359, 86360, 86361, and 86367.
Flow cytometry services are payable under Medicare Part B at specified places of service according to CPT: groups of CPTs have defined allowable POS (see mapping in policy).
MolDX blood product molecular antigen typing panels 0001U and 0084U (germline tests) are covered for beneficiaries but are limited to one test per beneficiary lifetime.

20 Active Policies

CGS-J15-L38249, MolDX: Blood Product Molecular Antigen Typing

J15

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-L38249

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When using an Advance Beneficiary Notice of Non‑coverage (ABN) with modifier GA, the ABN Form CMS‑R‑131 must be signed by the beneficiary (or properly witnessed if refused) and Part A MAC claims require occurrence code 32 plus the ABN date.

Use modifier GX when a voluntary ABN was signed and denial is anticipated for reasons other than medical necessity; use modifier GZ when denial is expected and no ABN is signed; use modifier GY for statutorily non‑covered services (no ABN required).

, MolDX: Blood Product Molecular Antigen Typing

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

J18

A59004, Billing and Coding: MolDX: Minimal Residual Disease Testing for Hematologic Cancers

A57110, Billing and Coding: MolDX: Blood Product Molecular Antigen Typing

WPS-J5-L38441, MolDX: Blood Product Molecular Antigen Typing

WPS-J5-L38835, MolDX: Minimal Residual Disease Testing for Cancer

WPS-J5-L39040, MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer

A58756, Billing and Coding: MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer

A59101, Billing and Coding: Off-label Use of Rituximab and Rituximab Biosimilars

NGS-J6-L39297, Off-label Use of Rituximab and Rituximab Biosimilars

WPS-J8-L38835, MolDX: Minimal Residual Disease Testing for Cancer

WPS-J8-L39040, MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer

WPS-J8-L38441, MolDX: Blood Product Molecular Antigen Typing

NGS-JK-L39297, Off-label Use of Rituximab and Rituximab Biosimilars

A56421, Billing and Coding: CT of the Abdomen and Pelvis

A56464, Billing and Coding: Flow Cytometry

Z85.72, Personal history of non-Hodgkin lymphomas