Does C83.80 require prior authorization?

No, C83.80 does not require prior authorization (high confidence). Code is covered without prior authorization.

Verity

`C83.80` — Other non-follicular lymphoma, unspecified site

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

L34658 — Vitamin D Assay Testing

J05

A57484 — Billing and Coding: Vitamin D Assay Testing

J05

A59004 — Billing and Coding: MolDX: Minimal Residual Disease Testing for Hematologic Cancers

J05

L38835 — MolDX: Minimal Residual Disease Testing for Cancer

J05

L39477

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When reporting the JW modifier for discarded drug, the medical record must clearly show the amount administered and the amount wasted.

Medical record must document prior anthracycline therapy for patients receiving albumin-bound paclitaxel, or clearly document a clinical contraindication to anthracycline therapy.

— Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin's and Non-Hodgkin's Lymphoma with B-cell or T-cell Origin

A59259 — Billing and Coding: Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin's and Non-Hodgkin's Lymphoma with B-cell or T-cell Origin

J05

L39297 — Off-label Use of Rituximab and Rituximab Biosimilars

J06

L39513 — Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin and Non-Hodgkin Lymphoma with B-cell or T-cell Origin

J06

A52450 — Billing and Coding: Paclitaxel (e.g., Taxol/Abraxane )

J06

A59901 — Billing and Coding: Bevacizumab and biosimilars

J06

A59926 — Billing and Coding: Molecular Pathology Procedures

J06

A59101 — Billing and Coding: Off-label Use of Rituximab and Rituximab Biosimilars

J06

L35000 — Molecular Pathology Procedures

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

A59311 — Billing and Coding: Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin and Non-Hodgkin Lymphoma with B-cell or T-cell Origin

J06

A60186 — Billing and Coding: Off-label Use of Rituximab and Rituximab Biosimilars

J06

A56199 — Billing and Coding: Molecular Pathology Procedures

J06

L36850 — Peripheral Nerve Blocks

J06

C83.80 — Other non-follicular lymphoma, unspecified site