Does Z94.89 require prior authorization?

No, Z94.89 does not require prior authorization (high confidence). Covered without prior authorization.

`Z94.89`, Other transplanted organ and tissue status

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

When reporting the JW modifier for discarded drug, the medical record must clearly show the amount administered and the amount wasted.
Medical record must document prior anthracycline therapy for patients receiving albumin-bound paclitaxel, or clearly document a clinical contraindication to anthracycline therapy.
For claims with no discarded amounts from single-dose containers or single-use packages, include the JZ modifier as evidence on the claim (effective July 1, 2023).
Document dose and frequency as consistent with the FDA label or recognized compendia for the indication (including citations to the compendia if used for off-label indications).

Paclitaxel administered intravenously is covered for antineoplastic (cancer) indications when used in accordance with the FDA-approved labeling.
Off-label uses of paclitaxel are covered when supported by recognized compendia (e.g., NCCN, AHFS, Clinical Pharmacology, Lexi-Drugs, Micromedex) and dosing/frequency follow those compendia.
Albumin-bound paclitaxel (Abraxane) is covered when prior therapy included an anthracycline unless anthracycline therapy is clinically contraindicated.
Immunosuppressive drugs are covered when prescribed following a covered organ transplant of kidney, heart, liver, bone marrow/stem cell, lung, or combined heart-lung.
Immunosuppressive drugs are covered after a whole-organ pancreas transplant that was performed concurrent with or subsequent to a kidney transplant for diabetic nephropathy when the transplant was performed on or after 1999-07-01.
Immunosuppressive drugs are covered after an intestinal transplant performed on or after 2001-04-01.

CGS-J15-L34337, Transesophageal Echocardiography (TEE)

J15

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

J15

CGS-J18-L39038, MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

J18

CGS-J18-L34337, Transesophageal Echocardiography (TEE)

J18

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