Does D59.9 require prior authorization?

No, D59.9 does not require prior authorization (high confidence). Code is covered without prior authorization.

`D59.9` — Acquired hemolytic anemia, unspecified

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

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.
Include the appropriate ICD-10-CM diagnosis code on the claim when reporting the blood product molecular antigen typing service.

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.
Comprehensive blood product molecular antigen typing panels (e.g., codes 0001U and 0084U) are recognized as germline blood product antigen typing tests.
Flow cytometry is covered for examination of body fluids (including peripheral blood and cerebrospinal fluid), bone marrow, and lymphoreticular tissues (lymph nodes, tonsil, spleen).
Peripheral blood and fine needle aspirate specimens are acceptable for flow cytometry to avoid more invasive diagnostic procedures.
Coverage decisions are governed by the associated Local Coverage Determination LCD L34215 and its specific coverage criteria.
Panel codes 0001U and 0084U for blood product molecular antigen typing are covered when billed as a panel.

A57110 — Billing and Coding: MolDX: Blood Product Molecular Antigen Typing

J05

L38441 — MolDX: Blood Product Molecular Antigen Typing

J05

L40180 — Off-label Use of Rituximab and Rituximab Biosimilars

J06

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

J06

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