M35.07 — Sjogren syndrome with central nervous system involvement
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.
- Medical records must document the medical necessity of the serum magnesium test, including the signs, symptoms, and/or diagnosis that prompted the test.
- Laboratories must maintain the physician's order for the serum magnesium test in their records.
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.
- ICD-10-CM Codes that Support Medical Necessity — Group 1 (covered diagnoses): D56.1 - Beta thalassemia
- ICD-10-CM Codes that Support Medical Necessity — Group 1 (covered diagnoses): D57.02 - Hb-SS disease with splenic sequestration
- ICD-10-CM Codes that Support Medical Necessity — Group 1 (covered diagnoses): D57.1 - Sickle-cell disease without crisis
- ICD-10-CM Codes that Support Medical Necessity — Group 1 (covered diagnoses): D57.212 - Sickle-cell/Hb-C disease with splenic sequestration
20 Active Policies
A57478 — Billing and Coding: Nerve Conduction Studies and Electromyography
J05
A55639 — Billing and Coding: Chemotherapy Agents for Non-Oncologic Conditions
J05
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
Related Codes
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