D82.9 — Immunodeficiency associated with major defect, 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.
- The medical record must fully support medical necessity per the LCD, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
- For diagnostic tests, report the test result on the claim if known; if the result is not known at submission, report the symptoms prompting the performance of the test.
- When a specialist order permits billing outside specified POS, documentation of the specialist communication in the medical record is required.
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.
- When billed outside the specified POS, the test is covered if ordered by a diagnosing/treating specialist in Infectious Diseases, Gastroenterology, Oncology, or Transplant, with specialist communication documented in the medical record.
- Multiplex GPP tests for diagnosis of acute gastroenteritis (AGE) are covered when billed in POS 20, 21, 22, 23, or 81.
- Multiplex GPP tests are covered when ordered as part of a pre-transplant evaluation for an immunocompromised beneficiary and billed in POS 81 (Independent Laboratory).
- An access-based exception may permit coverage for tests ordered by non-specialists outside the specified POS when the beneficiary cannot reasonably reach a specialist (e.g., rural or island locations) and the ordering provider is closer to the beneficiary; this must be documented.
- IVIG is covered for hyperimmunoglobulinemia E (hyper-IgE) syndrome.
6 Active Policies
A58963 — Billing and Coding: Multiplex Gastrointestinal Pathogen Panel (GPP) Tests for Acute Gastroenteritis (AGE)
J06
L39226 — Multiplex Gastrointestinal Pathogen Panel (GPP) Tests for Acute Gastroenteritis (AGE)
J06
ANTHEM-MP-A047560 — TRANS.00029 Hematopoietic Stem Cell Transplantation for Genetic Diseases and Aplastic Anemias
ANTHEM-CG-LAB-14 — CG-LAB-14 Respiratory Viral Panel Testing in the Outpatient Setting
Related Codes
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