Does 86822 require prior authorization?

No, 86822 does not require prior authorization (high confidence). Code is covered without prior authorization.

`86822`

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

If requesting coverage for adult >45 years, documentation to support submission to NME (per policy instruction to forward such requests).
Transplanting institution's written eligibility criteria (member must meet these criteria for coverage).
When transplanting institution criteria are not available, documentation of donor relationship: evidence that the donor is haploidentical to HLA-matched donor (HLA typing/compatibility testing results).
For sickle cell anemia cases covered under the 'absence of criteria' pathway: documentation of history of stroke or documentation that the member is at increased risk of stroke or end-organ damage (examples to document include recurrent chest syndrome, recurrent vaso-occlusive crises, red blood cell alloimmunization on chronic transfusion therapy).

Note (from policy): Factors associated with increased risk of stroke or end-organ damage include recurrent chest syndrome, recurrent vaso-occlusive crises, and red blood cell alloimmunization on chronic transfusion therapy.
ICD-10 codes listed as covered diagnoses (per CPB): D56.1 (Beta thalassemia); D57.00 - D57.819 (Sickle-cell disorders).
Covered ICD-10 diagnoses associated with the selection criteria: D56.1 (Beta thalassemia) and D57.00 - D57.819 (Sickle-cell disorders).
Aetna considers allogeneic hematopoietic cell transplantation medically necessary for the following: For the treatment of thalassemia major (i.e., homozygous beta-thalassemia) in children or young adults (to age 45 years) when the member meets transplanting institution's written eligibility criteria.
Aetna considers allogeneic hematopoietic cell transplantation medically necessary for the treatment of thalassemia major (i.e., homozygous beta-thalassemia) in children or young adults with a haploidentical to human leukocyte antigen (HLA)-matched donor (in the absence of transplanting institution's written eligibility criteria).
Aetna considers allogeneic hematopoietic cell transplantation medically necessary for the treatment of sickle cell anemia in children or young adults when the member meets transplanting institution's written eligibility criteria.

AETNA-CPB-0626 — Hematopoietic Cell Transplantation for Thalassemia Major and Sickle Cell Anemia

BCBSIL-SUR703.029 — Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia (CLL) and Small Lymphocytic Lymphoma (SLL)

BCBSMT-SUR703.029 — Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia (CLL) and Small Lymphocytic Lymphoma (SLL)

BCBSNM-SUR703.029 — Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia (CLL) and Small Lymphocytic Lymphoma (SLL)

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