Does N03.A require prior authorization?

No, N03.A does not require prior authorization (high confidence). Code is covered without prior authorization.

`N03.A` — Chronic nephritic syndrome with C3 glomerulonephritis

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

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.
The provided policy text does not specify required documentation (e.g., prior authorization forms, specific tests); documentation requirements for coverage (especially for off-label uses) should be confirmed with the A/B MAC.

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.
Rituximab is covered in previously untreated diffuse large B-cell, CD20-positive NHL in combination with CHOP or other anthracycline-based chemotherapy regimens.
Rituximab in combination with fludarabine and cyclophosphamide (FC) is covered for the treatment of previously untreated and previously treated CD20-positive chronic lymphocytic leukemia (CLL).
Rituximab with methotrexate is covered for adult patients (age >=18) with moderately to severely active rheumatoid arthritis (RA) who have had an inadequate response to one or more tumor necrosis factor (TNF) antagonist therapies.

ANTHEM-CG-MED-68 — CG-MED-68 Therapeutic Apheresis

ANTHEM-CG-DME-41 — CG-DME-41 Ultraviolet Light Therapy Delivery Devices for Home Use

A56380 — Billing and Coding: Rituximab

L35026 — Rituximab

Ask Verity about documentation requirements, denial risks, or coverage in your state.