Does Z85.9 require prior authorization?

No, Z85.9 does not require prior authorization (high confidence). Code is covered without prior authorization.

`Z85.9`, Personal history of malignant neoplasm, unspecified

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Use CPT codes 78472, 78473, 78481, 78483, 78494, or 78496 when billing cardiac blood pool imaging (MUGA, ventriculography).
When applicable, include the additional secondary code indicating personal history of malignant neoplasm (Z85 series) per Correct Coding Initiative (CCI) guidelines alongside the appropriate C-code or D-code family entry.
Refer to the policy's Covered ICD-10 Codes section to select the appropriate C-code, D-code, and Z85 family codes for billing cardiac blood pool imaging.
When billing Part B claims, include the drug(s) being considered that require the PGx test on the applicable detail line (eg, 2400 loop on 837P); for Part A include Loop SV202-7 (837I) or Block 80 (UB04); for paper Part B include Box 19.

Cardiac blood pool imaging (MUGA, ventriculography) is covered when performed for patients receiving cardiotoxic chemotherapy.
Cardiac blood pool imaging is covered for evaluation of valvular disease or cardiomyopathies.
Prior to initiation of cardiotoxic chemotherapy, bill cardiac blood pool imaging with ICD-10 code Z01.89 plus the appropriate C-code or D-code family entry.
During or for interval assessment while receiving cardiotoxic chemotherapy, bill using the appropriate T45.1X5* encounter code (T45.1X5A, T45.1X5D, or T45.1X5S) to indicate ongoing exposure.
At completion of cardiotoxic chemotherapy, bill cardiac blood pool imaging with ICD-10 code Z08 and the appropriate C-code or D-code family entry.
Pharmacogenomics (PGx) testing is covered when it is reasonable and necessary per LCD L39063 and Medicare coverage rules for the beneficiary's clinical indication.

NGS-J6-L39995, Pharmacogenomic Testing

A59915, Billing and Coding: Pharmacogenomic Testing

FIRST_COAST-L39073, Pharmacogenomics Testing

A58812, Billing and Coding: Pharmacogenomics Testing

NOVITAS-JH-L39063

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