M31.11 — Hematopoietic stem cell transplantation-associated thrombotic microangiopathy [HSCT-TMA]
ICD-10-CM
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- Claims must be supported by medical record documentation of the patient’s diagnosis/clinical condition and justification that the selected drug, dose, and route of administration are appropriate and medically necessary for the non-oncologic indication.
- Billing must comply with Medicare rules and any applicable LCD prior authorization or documentation requirements; follow any specific forms or prior authorization processes required by the LCD or payer.
- A permanent record of the studies performed and the interpretation must be maintained in the medical record.
- The report must describe the studies performed and document any contrast media and/or radiopharmaceuticals used.
Key Coverage Criteria
- Anti-neoplastic (chemotherapy) agent CPT/HCPCS codes may be used to bill for administration of these drugs when given to treat non-oncologic (noncancer) diagnoses if the drug is medically necessary for the patient’s condition and consistent with the standard of medical practice.
- Monoclonal antibody agents and other biologic response modifiers may be administered and billed using chemotherapy administration codes for noncancer indications when the dose, route, and clinical use are appropriate and medically necessary.
- Non-invasive cerebrovascular/vascular studies are covered when the study results will be used to directly inform or change the clinical management of the patient.
- Re-evaluation of carotid artery stenosis is covered for patients with diameter reduction >50% who are symptomatic and these patients are normally followed on an annual basis.
- Re-evaluation of carotid artery stenosis is covered for patients with diameter reduction >60% who are asymptomatic and these patients are normally followed on an annual basis.
- Repeat duplex ultrasound scans are covered at any time for patients who become symptomatic of carotid disease, without regard to scheduled surveillance intervals.
20 Active Policies
L35761 — Non-Invasive Peripheral Arterial Vascular Studies
J05
A55639 — Billing and Coding: Chemotherapy Agents for Non-Oncologic Conditions
J05
L37205 — Chemotherapy Drugs and their Adjuncts
J05
A57592 — Billing and Coding: Non-Invasive Cerebrovascular Studies
J05
A57593
Related Codes
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