Does C92.02 require prior authorization?

No, C92.02 does not require prior authorization (high confidence). Code is covered without prior authorization.

`C92.02` — Acute myeloblastic leukemia, in relapse

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Use CPT 81120 to report Abbott RealTime IDH1 for claims dated on or after 2018-07-20 and CPT 81121 to report Abbott RealTime IDH2 for claims dated on or after 2018-01-01.
Enter 1 unit of service (UOS) per test on the claim.
Include the appropriate DEX Z‑Code™ identifier adjacent to the CPT code in the comment/narrative field for Part B claims (Loop 2400 or SV101-7 for 837P; Box 19 for paper claims).
Include the appropriate DEX Z‑Code™ identifier adjacent to the CPT code for Part A claims (Line SV202-7 for 837I electronic claims; Block 80 for UB04).

Abbott RealTime IDH1 (Abbott Molecular) is FDA‑approved to identify adult AML patients with a susceptible IDH1 mutation to aid selection of treatment with ivosidenib and is covered by Medicare effective 2018-07-20.
Abbott RealTime IDH2 (Abbott Molecular) is FDA‑approved to identify adult AML patients with a susceptible IDH2 mutation to aid selection of treatment with enasidenib and is covered by Medicare effective 2017-08-01.
Testing is indicated for adult patients with relapsed or refractory acute myeloid leukemia when a susceptible IDH1 or IDH2 mutation will inform use of the corresponding FDA‑approved targeted therapy.
When a molecular panel of 5–50 genes is ordered, bill the appropriate panel CPT code (81445, 81449, 81450, or 81451) instead of submitting individual single-gene CPT codes.
When 51 or more genes are ordered for molecular biomarkers, bill the appropriate large-panel CPT code (81455 or 81456) rather than individual gene codes.
When a panel contains more than one but fewer than five genes, use the corresponding existing panel CPT code or CPT 81479 (unlisted molecular pathology procedure) if no specific panel CPT exists.

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

J05

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

J05

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

J05

A57878 — Billing and Coding: MolDX: Next-Generation Sequencing Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies

J05

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