Does B25.1 require prior authorization?

No, B25.1 does not require prior authorization (high confidence). Code is covered without prior authorization.

`B25.1` — Cytomegaloviral hepatitis

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Claims should reference and be supported by LCD L34580 and follow the billing/coding guidelines in this article; specific documentation requirements (e.g., medical records, prior authorization) are those detailed in LCD L34580.
Treating physician must clearly document medical necessity to initiate IVIg therapy and the continued need for ongoing therapy in the medical record.
Include a History and Physical (H&P) in the medical record supporting IVIg therapy.
Include office and/or progress notes that document clinical status, response, and ongoing need for IVIg.

Billing and coding for intravenous immunoglobulin (IVIG) should follow the Local Coverage Determination (LCD) L34580 and the billing/coding guidelines in this article as a complement to that LCD.
IVIg (intravenous immune globulin) is covered when medically necessary as determined and documented by the treating physician, consistent with the associated Local Coverage Determination (LCD).
Molecular syndromic infectious disease panels are covered when billed with the appropriate proprietary CPT®/PLA code (or CPT® 87999 if no specific code exists) and accompanied by ICD-10-CM diagnosis codes that support medical necessity documented in the patient record.
FDA-approved or cleared molecular infectious disease tests performed consistent with their intended use labeling are covered without a DEX Z-Code and Technical Assessment when billed with appropriate ICD-10-CM diagnosis codes and supporting documentation.
Expanded (>5 pathogens) respiratory (RP/PNP) and gastrointestinal (GI) panels are covered if billed from place of service (POS) 19, 21, 22, or 23, or if ordered by an appropriate specialist depending on beneficiary immune status and the specialist is diagnosing/treating the beneficiary.
For immune-compromised beneficiaries, expanded panels (RP/PNP/GI/other panels) are covered when ordered by a specialist in Infectious Diseases, Oncology, Transplant, Pulmonology (for RP/PNP), or Gastroenterology (for GI) who is diagnosing and treating the beneficiary.

A58761 — Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

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L39044 — MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

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L40181 — Off-Label Use of Intravenous Immune Globulin (IVIG)

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A59105 — Billing and Coding: Off-Label Use of Intravenous Immune Globulin (IVIG)

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