Does D49.1 require prior authorization?

No, D49.1 does not require prior authorization (high confidence). Code is covered without prior authorization.

`D49.1` — Neoplasm of unspecified behavior of respiratory system

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

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.
For claims with no discarded amounts from single-dose containers or single-use packages, include the JZ modifier as evidence on the claim (effective July 1, 2023).
Document dose and frequency as consistent with the FDA label or recognized compendia for the indication (including citations to the compendia if used for off-label indications).

Paclitaxel administered intravenously is covered for antineoplastic (cancer) indications when used in accordance with the FDA-approved labeling.
Off-label uses of paclitaxel are covered when supported by recognized compendia (e.g., NCCN, AHFS, Clinical Pharmacology, Lexi-Drugs, Micromedex) and dosing/frequency follow those compendia.
Albumin-bound paclitaxel (Abraxane) is covered when prior therapy included an anthracycline unless anthracycline therapy is clinically contraindicated.
An oral antiemetic drug is covered when it has been ordered by the treating practitioner as part of a cancer chemotherapy regimen.
An oral antiemetic drug is covered when the drug is FDA‑approved for use as an antiemetic.
An oral antiemetic drug is covered when it is used as a full therapeutic replacement for an intravenous antiemetic that would otherwise have been administered at the time of the chemotherapy treatment.

A55147 — Billing and Coding: MolDX: bioTheranostics Cancer TYPE ID Update

J05

L36807 — MolDX: Molecular Diagnostic Tests (MDT)

J05

L36850 — Peripheral Nerve Blocks

J06

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

J06

A57452

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