D55.9 — Anemia due to enzyme disorder, unspecified
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- 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.
- Select and report the appropriate CPT or PLA code for the blood product molecular antigen typing service and enter the unit of service (UOS) on the claim.
- For Part B claims, enter the appropriate DEX Z-Code identifier adjacent to the CPT/PLA code in the comment/narrative field: use Loop 2400 or SV101-7 for 5010A1 837P electronic claims or Box 19 for paper claims.
- For Part A claims, enter the appropriate DEX Z-Code identifier adjacent to the CPT/PLA code in the comment/narrative field: use Line SV202-7 for 837I electronic claims or Block 80 for the UB04 claim form.
Key Coverage Criteria
- 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.
- MolDX blood product molecular antigen typing panels 0001U and 0084U (germline tests) are covered for beneficiaries but are limited to one test per beneficiary lifetime.
- Blood Product Molecular Antigen Typing is covered when ordered consistent with the applicable MolDX Local Coverage Determination (LCD) clinical indications.
- Blood product molecular antigen typing panels 0001U and 0084U are covered as germline tests when billed consistent with MolDX LCD L38249.
- Comprehensive blood product molecular antigen typing panels (e.g., codes 0001U and 0084U) are recognized as germline blood product antigen typing tests.
- Panel codes 0001U and 0084U for blood product molecular antigen typing are covered when billed as a panel.
12 Active Policies
L38441 — MolDX: Blood Product Molecular Antigen Typing
J05
A57110 — Billing and Coding: MolDX: Blood Product Molecular Antigen Typing
J05
A57155 — Billing and Coding: MolDX: Blood Product Molecular Antigen Typing
A57376 — Billing and Coding: MolDX: Blood Product Molecular Antigen Typing
A58308 — Billing and Coding: MolDX: Blood Product Molecular Antigen Typing
Related Codes
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