Does 86999 require prior authorization?

No, 86999 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 86999?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

Verity

`86999`

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Key Coverage Criteria

Donor* lymphocyte infusion is consideredmedically necessaryfor individuals following a medically necessary allogeneic (myeloablative or non-myeloablative) hematopoietic progenitor cell transplant used to treat a hematologic malignancy.
*Note:The donor for the lymphocytes is the same individual whose hematopoietic progenitor cells were used for the transplant procedure.
Collection and cryopreservation of donor lymphocytes is consideredmedicallynecessaryprior to, at the time of, or after a medically necessary allogeneic or non-myeloablative allogeneic hematopoietic progenitor cell transplant.

1 Active Policy

ANTHEM-CG-TRANS-03 — CG-TRANS-03 Donor Lymphocyte Infusion for Hematologic Malignancies after Allogeneic Hematopoietic Progenitor Cell Transplantation

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86999