Does D72.18 require prior authorization?

No, D72.18 does not require prior authorization (high confidence). Code is covered without prior authorization.

`D72.18` — Eosinophilia in diseases classified elsewhere

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Claims must include the appropriate CPT code, 1 unit of service (UOS), and the appropriate ICD-10-CM diagnosis code.
Additional medical necessity documentation must be submitted when more than 24 markers are tested.
Follow the associated Local Coverage Determination LCD L34215 for full documentation and coverage requirements not detailed here.
Claims must document adherence to LCD L39365 and to AMA CPT Codebook and Medicare NCCI Policy Manual rules and guidelines; providers billing Medicare are expected to follow all instructions in these sources.

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.
Genetic testing CPT codes are covered when testing is reasonable and necessary per Local Coverage Determination L39365 and the AMA CPT Codebook and Medicare NCCI Policy Manual instructions are followed.
If a CPT code specifies a medical condition (e.g., CPT 81432 - hereditary breast cancer-related disorders), bill that code only when the beneficiary's documented disease matches the code's described medical condition and all genes billed under that code relate to that condition.
When a CPT genomic sequencing panel (GSP) code defines required genes (e.g., CPT 81436), bill the panel code only if the test includes all mandatory genes listed in the code description; bill the panel as a single unit of service regardless of the number of genes tested.

A59492 — Billing and Coding: Genetic Testing for Oncology

J09

A59491 — Billing and Coding: Genetic Testing for Oncology

J12

A57690 — Billing and Coding: Lab: Flow Cytometry

A57689 — Billing and Coding: Lab: Flow Cytometry

L34215 — Lab: Flow Cytometry

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