Does I78.0 require prior authorization?

No, I78.0 does not require prior authorization (low confidence). No active coverage policies found for this code.

Verity

`I78.0` — Hereditary hemorrhagic telangiectasia

ICD-10-CM

Prior Authorization

No Prior Auth Required

No active coverage policies found for this code (low confidence)

Documentation Required

The intravitreal injection procedure must be coded using CPT code 67028 and the appropriate RT, LT, or 50 site modifier must be appended to indicate unilateral or bilateral service.
Dose and frequency for bevacizumab and biosimilars must follow the FDA label or recognized compendia for off-label uses; compendia cited include AHFS, Clinical Pharmacology, Lexi-Drugs, Micromedex DrugDex, NCCN, FDA, and USP.
When billing for metastatic (secondary) disease, use the code for the primary malignancy if the primary tumor is still present, and use the appropriate personal history 'Z' code if the primary malignancy is no longer present.
For Part A and Part B submissions, follow the respective HCPCS coding guidance provided (codes differ by drug form, biosimilar, and effective dates); bill units consistent with the indicated HCPCS code descriptions.

Key Coverage Criteria

For non-ophthalmologic (systemic) use, bevacizumab must be reported with HCPCS code J9035 (injection, bevacizumab, 10 mg) with units reflecting multiples of 10 mg provided.
For non-ophthalmologic use, bevacizumab-awwb (MVASI) must be reported with HCPCS code Q5107 (10 mg).
For non-ophthalmologic use, bevacizumab-bvzr (ZIRABEV) must be reported with HCPCS code Q5118 (10 mg).
Bevacizumab-maly (ALYMSYS/ALYMSYS1) is reported with HCPCS code C9142 for 10/01/2022–12/31/2022 and with HCPCS code Q5126 effective 01/01/2023 (10 mg).
Bevacizumab-adcd (Vegzelma) should be reported with HCPCS code Q5129 effective 04/01/2023.
For the period 09/27/2022 through 03/31/2023 bevacizumab-maly could be reported with miscellaneous code J3590 (per guidance for that timeframe).

20 Active Policies

A56394 — Billing and Coding: Colonoscopy and Sigmoidoscopy-Diagnostic

J05

L34614 — Colonoscopy and Sigmoidoscopy-Diagnostic

J05

A59901 — Billing and Coding: Bevacizumab and biosimilars

J06

A52870 — Billing and Coding: Treatment of Varicose Veins of the Lower Extremity

J06

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Claims submitted without a valid ICD-10-CM diagnosis code will be returned as incomplete; the diagnosis code must best describe the patient's condition for the service performed.

The patient's medical record must contain documentation fully supporting medical necessity including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.

— Billing and Coding: Bevacizumab and biosimilars

L33575 — Varicose Veins of the Lower Extremity, Treatment of

J06

L33394 — Drugs and Biologicals, Coverage of, for Label and Off-Label Uses

J06

L38720 — Treatment of Chronic Venous Insufficiency of the Lower Extremities

J09

A57063 — Billing and Coding: Diagnostic and Therapeutic Esophagogastroduodenoscopy

J09

A58250 — Billing and Coding: Treatment of Chronic Venous Insufficiency of the Lower Extremities

J09

L33583 — Diagnostic and Therapeutic Esophagogastroduodenoscopy

J09

L34924 — Treatment of Chronic Venous Insufficiency of the Lower Extremities

J12

A55229 — Billing and Coding: Treatment of Chronic Venous Insufficiency of the Lower Extremities

J12

A56730 — Billing and Coding: Respiratory Therapy and Oximetry Services

A56632 — Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy

A57204 — Billing and Coding: MRI and CT Scans of the Head and Neck

A57305 — Billing and Coding: Varicose Veins of the Lower Extremity, Treatment of

A57342 — Billing and Coding: Diagnostic and Therapeutic Colonoscopy

A57706 — Billing and Coding: Treatment of Varicose Veins of the Lower Extremities

A56456 — Billing and Coding: Colonoscopy/Sigmoidoscopy/Proctosigmoidoscopy

I78.0 — Hereditary hemorrhagic telangiectasia