Does D80.1 require prior authorization?

No, D80.1 does not require prior authorization (high confidence). Code is covered without prior authorization.

`D80.1` — Nonfamilial hypogammaglobulinemia

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

All documentation must be maintained in the patient's medical record, be legible, include patient identification (e.g., full name, dates of service) on every page, and include the legible signature of the physician or non-physician practitioner responsible for care.
The submitted medical record must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
Records must be made available to the contractor upon request.
Claims missing required NOC narrative information or with incorrect unit reporting will be rejected as unprocessable and may show remark code M123.

Gastrointestinal pathogen (GIP) multiplex NAAT panels (CPT 87505, 87506, 87507) are covered when reasonable and necessary in accordance with LCD L38229.
Billing and coding guidance in this article applies when immune globulin use meets the reasonable and necessary coverage criteria established in LCD L35093.
25-hydroxy vitamin D testing (including fractions, if performed) is covered when deemed reasonable and necessary per Local Coverage Determination L33771.
IVIG is covered only for indications specified as covered in the related Local Coverage Determination (LCD) and when medical necessity criteria in that LCD are met.
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.

A57554 — Billing and Coding: Immune Globulins

J05

A58761 — Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

J05

L34771 — Immune Globulins

J05

L39044 — MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

J05

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