Does Z94.0 require prior authorization?

No, Z94.0 does not require prior authorization (high confidence). Covered without prior authorization.

`Z94.0`, Kidney transplant status

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Medical records must document the indication(s) supporting use of IVIG for each claim.
For indications where routine IVIG use is not indicated, the medical record must document prior interventions that were unsuccessful or reasons those interventions were not tolerated.
Documentation must support objective clinical response to IVIG for continued coverage.
Medical records must be made available to the Contractor upon request to substantiate coverage and payment.

IVIG is covered only for indications specified as covered in the related Local Coverage Determination (LCD) and when medical necessity criteria in that LCD are met.
Flow cytometry is covered to detect antigens used as therapeutic targets in neoplastic disease.
Flow cytometry is covered for diagnosis and classification of hematopoietic neoplasms.
Flow cytometry is covered to assess biologic parameters associated with prognosis in hematopoietic neoplasms.
Flow cytometry is covered to detect residual neoplastic cells following therapy (minimal residual disease detection).
Flow cytometry is covered to monitor lymphocyte populations in patients with HIV infection.

CGS-J15-L35891, Intravenous Immune Globulin

J15

CGS-J15-L39038, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

J15

CGS-J15-L34037, Flow Cytometry

J15

CGS-J15-L38582, MolDX: Molecular Testing for Solid Organ Allograft Rejection

J15

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