Does Z94.9 require prior authorization?

No, Z94.9 does not require prior authorization (high confidence). Covered without prior authorization.

`Z94.9`, Transplanted organ and tissue status, unspecified

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Claims must report the appropriate CPT code for the flow cytometry service, include 1 unit of service (UOS), and list the appropriate ICD-10-CM diagnosis code.
Medical necessity documentation per LCD L34513 is required when coverage criteria are not fully met in this billing guideline (for example, when >24 markers are requested).
The patient's medical record must include the assessment by the ordering provider as it relates to the patient's complaint for that visit.
The medical record must include relevant medical history and results of pertinent tests/procedures.

Coverage and medical necessity determinations for flow cytometry are governed by Local Coverage Determination L34513.
Flow cytometry may be used to analyze cellular components of body fluids and lymphoreticular tissues, including peripheral blood, cerebrospinal fluid (CSF), bone marrow, lymph nodes, tonsil, spleen, and fine needle aspirate material.
Peripheral blood or fine needle aspirate specimens may be used to avoid more invasive diagnostic procedures when clinically appropriate.
Flow cytometry is covered for examination of body fluids (including peripheral blood and cerebrospinal fluid), bone marrow, and lymphoreticular tissues (lymph nodes, tonsil, spleen).
Peripheral blood and fine needle aspirate specimens are acceptable for flow cytometry to avoid more invasive diagnostic procedures.
Coverage decisions are governed by the associated Local Coverage Determination LCD L34215 and its specific coverage criteria.

CGS-J15-L34337, Transesophageal Echocardiography (TEE)

J15

CGS-J18-L34337, Transesophageal Echocardiography (TEE)

J18

ANTHEM-CG-SURG-90, Mohs Micrographic Surgery

AETNA-CPB-0351, Flow Cytometry, Ektacytometry, DNA Ploidy, and S-phase Fraction

AETNA-CPB-0638, Donor Lymphocyte Infusion

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