Does D68.59 require prior authorization?

No, D68.59 does not require prior authorization (high confidence). Code is covered without prior authorization.

`D68.59` — Other primary thrombophilia

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Policy content not provided; unable to determine required documentation, prior authorization, or forms for AICC claims—manual review of the full policy required.
The referring physician/nonphysician practitioner must state the clinical indication/medical necessity in the order for the test and provide the order to the performing provider.
The medical record must include a permanent report describing studies performed, any contrast or radiopharmaceuticals used, known significant reactions/complications, and comparisons with prior relevant studies.
Reports must document both normal and abnormal findings, measurements for variations from normal, and explicitly address the clinical question or explain why it cannot be answered.

Policy content not provided; unable to determine covered indications for AICC NCD 110.3—manual review of the full policy required.
Non-invasive peripheral venous and hemodialysis access studies are covered when the results will be used to guide the clinical management of the patient.
Duplex scanning and physiologic studies may be performed and reimbursed during the same encounter when physiologic studies are abnormal or when evaluating vascular trauma, thromboembolic events, or aneurysmal disease.
One preoperative scan for hemodialysis access site surgery is covered to plan access creation.
Pre-surgical radial artery conduit mapping may be accompanied by vein mapping only when arterial studies show an unacceptable conduit or insufficient arterial conduit is available for multiple bypass procedures.
Non-invasive peripheral venous vascular studies are medically necessary when all three conditions are met: signs or symptoms of ischemia or altered blood flow are present; the information is necessary for appropriate medical or surgical management; and the test is not redundant of other diagnostic procedures.

A57594 — Billing and Coding: Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies

J05

L35751 — Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies

J05

AMBETTER-CG-Hema-Cond-(nonCA)--2025.1 — Concert Genetic Testing: Hematologic Conditions (non-cancerous)

CIGNA-0538 — Flow Cytometry - (0538)

A56065

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