Does C45.2 require prior authorization?

No, C45.2 does not require prior authorization (high confidence). Code is covered without prior authorization.

Verity

`C45.2` — Mesothelioma of pericardium

ICD-10-CM

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Documentation Required

The intravitreal injection procedure must be coded using CPT code 67028 and the appropriate RT, LT, or 50 site modifier must be appended to indicate unilateral or bilateral service.
Dose and frequency for bevacizumab and biosimilars must follow the FDA label or recognized compendia for off-label uses; compendia cited include AHFS, Clinical Pharmacology, Lexi-Drugs, Micromedex DrugDex, NCCN, FDA, and USP.
When billing for metastatic (secondary) disease, use the code for the primary malignancy if the primary tumor is still present, and use the appropriate personal history 'Z' code if the primary malignancy is no longer present.
For Part A and Part B submissions, follow the respective HCPCS coding guidance provided (codes differ by drug form, biosimilar, and effective dates); bill units consistent with the indicated HCPCS code descriptions.

Key Coverage Criteria

For non-ophthalmologic (systemic) use, bevacizumab must be reported with HCPCS code J9035 (injection, bevacizumab, 10 mg) with units reflecting multiples of 10 mg provided.
For non-ophthalmologic use, bevacizumab-awwb (MVASI) must be reported with HCPCS code Q5107 (10 mg).
For non-ophthalmologic use, bevacizumab-bvzr (ZIRABEV) must be reported with HCPCS code Q5118 (10 mg).
Bevacizumab-maly (ALYMSYS/ALYMSYS1) is reported with HCPCS code C9142 for 10/01/2022–12/31/2022 and with HCPCS code Q5126 effective 01/01/2023 (10 mg).
Bevacizumab-adcd (Vegzelma) should be reported with HCPCS code Q5129 effective 04/01/2023.
For the period 09/27/2022 through 03/31/2023 bevacizumab-maly could be reported with miscellaneous code J3590 (per guidance for that timeframe).

20 Active Policies

L38835 — MolDX: Minimal Residual Disease Testing for Cancer

J05

A58468 — Billing and Coding: MolDX: Minimal Residual Disease Testing for Solid Tumor Cancers

J05

L40277 — MolDX: Non-Next Generation Sequencing Targeted Molecular Panel Tests for Predictive Testing in Cancer

J05

L35121 — Coronary Computed Tomography Angiography (CCTA)

J05

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

The patient's medical record must fully document medical necessity for the cardiac catheterization and support the diagnosis and procedures billed.

Each claim must include ICD-10-CM diagnosis code(s) that accurately reflect the patient's condition and reason for the procedure and these codes must be linked to the CPT procedure codes on the claim.

L38168 — MolDX: Plasma-Based Genomic Profiling in Solid Tumors

A60309 — Billing and Coding: MolDX: Non-Next Generation Sequencing Targeted Molecular Panel Tests for Predictive Testing in Cancer

J05

L39913 — Artificial Intelligence Enabled CT Based Quantitative Coronary Topography (AI-QCT)/Coronary Plaque Analysis (AI-CPA)

J05

A57552 — Billing and Coding: Coronary Computed Tomography Angiography (CCTA)

J05

A57858 — Billing and Coding: MolDX: Next-Generation Sequencing for Solid Tumors

J05

A57936 — Billing and Coding: MolDX: Plasma-Based Genomic Profiling in Solid Tumors

J05

L38158 — MolDX: Next-Generation Sequencing for Solid Tumors

J05

L35490 — Category III Codes

J05

A59901 — Billing and Coding: Bevacizumab and biosimilars

J06

A52868 — Billing and Coding: Transesophageal Echocardiography (TEE)

J06

A52850 — Billing and Coding: Cardiac Catheterization and Coronary Angiography

J06

L33394 — Drugs and Biologicals, Coverage of, for Label and Off-Label Uses

J06

A57452 — Billing and Coding: Peripheral Nerve Blocks

J06

A52370 — Billing and Coding: Bevacizumab and biosimilars

J06

A56781 — Billing and Coding: Transthoracic Echocardiography (TTE)

J06

A56737 — Billing and Coding: Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA)

J06

C45.2 — Mesothelioma of pericardium