D84.89 — Other immunodeficiencies
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- For pre-transplant evaluation of immune-compromised beneficiaries, clear documentation of the pre-transplant evaluation must accompany the claim.
- ICD-10-CM diagnosis codes supporting medical necessity must be submitted with each claim and the submitted medical record must support the selected ICD-10-CM code(s).
- Tests billed with CPT® 87999, or tests with other indicated uses, must include a DEX Z-Code and undergo a MolDX Technical Assessment (TA) as part of claim submission.
- If applicable, enter the DEX Z-Code adjacent to the CPT code in the specified claim fields (Part B: Loop 2400/SV101-7 or Box 19; Part A: Line SV202-7 or UB04 Block 80) and do not add extra characters to the SV101-7 field.
Key Coverage Criteria
- Molecular syndromic panels for infectious disease pathogen identification are covered when billed with the appropriate proprietary CPT®/PLA code (or acceptable CPT code) and accompanied by supporting ICD-10-CM diagnosis codes documented in the medical record that justify medical necessity.
- FDA-cleared/approved molecular infectious disease tests performed consistent with their FDA intended-use labeling are billable without a DEX Z-Code when accompanied by an appropriate ICD-10-CM code and documentation of medical necessity.
- Expanded (>5 pathogen) respiratory (RP), pneumonia (PNP), and gastrointestinal (GI) panels may be billed when either (a) the place of service is 19, 21, 22, or 23, or (b) the ordering provider is an appropriate specialist per immune-status and panel type and the claim includes the required ICD-10 codes (Group 6/7 plus signs/symptoms from Groups 1/2), with pre-transplant immune-compromised testing allowed regardless of symptoms with supporting documentation.
- Additional panel testing for content that is non-duplicative of an existing panel on the same date of service can be billed for the non-duplicative content if the medical record documents the non-duplication and all other policy criteria are met.
- Molecular syndromic infectious disease panels are covered when billed with the appropriate proprietary CPT® or PLA code and an accompanying ICD-10-CM diagnosis that documents medical necessity in the patient record.
- FDA-cleared/approved molecular infectious disease tests performed consistent with their intended use are covered without a DEX Z-code when billed with an appropriate supporting ICD-10-CM code.
20 Active Policies
A58761 — Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
J05
L39044 — MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing
J05
A58963 — Billing and Coding: Multiplex Gastrointestinal Pathogen Panel (GPP) Tests for Acute Gastroenteritis (AGE)
J06
L39995 — Pharmacogenomic Testing
J06
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.