M05.A — Abnormal rheumatoid factor and anti-citrullinated protein antibody with rheumatoid arthritis
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- Refer to Local Coverage Determination L35026 for clinical coverage criteria, medical necessity requirements, and any required prior authorization; this article complements that LCD with billing/coding guidance.
- Providers must follow the Local Coverage Determination (LCD) L35677 for clinical indications, coverage decisions, and documentation requirements for infliximab.
- The article provides billing and coding guidance and references LCD L39116; required documentation (e.g., medical records, prior authorization, specific forms) is not specified here and must be obtained from LCD L39116.
- This billing and coding article provides billing and coding guidance for Local Coverage Determination (LCD) L39575 regarding amniotic and placental-derived product injections/applications for musculoskeletal, non-wound indications.
Key Coverage Criteria
- No specific clinical indications are provided in this billing and coding article; coverage criteria for amniotic and placental-derived product injections/applications for musculoskeletal non-wound indications are described in Local Coverage Determination L39116.
- Coverage applies when the amniotic or placental-derived product injection/application meets the reasonable and necessary requirements of Local Coverage Determination L39877.
- Amniotic and placental-derived product injections/applications are covered only when they meet the reasonable and necessary clinical requirements specified in LCD L39879 (Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound).
- Rituximab is covered as a single agent for relapsed or refractory, low-grade or follicular, CD20-positive B-cell non-Hodgkin lymphoma (NHL).
- Rituximab is covered in previously untreated follicular, CD20-positive B-cell NHL in combination with first-line chemotherapy and, for patients achieving a complete or partial response, as single-agent maintenance therapy.
- Rituximab is covered as a single agent for non-progressing (including stable disease), low-grade, CD20-positive B-cell NHL after first-line cyclophosphamide, vincristine and prednisone (CVP) chemotherapy.
18 Active Policies
A59434 — Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound
J05
L39624 — Amniotic and Placental Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound
J05
L39877 — Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound
J09
A59764 — Billing and Coding: Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound
J09
Related Codes
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