Does T45.0X5A require prior authorization?

No, T45.0X5A does not require prior authorization (high confidence). Code is covered without prior authorization.

`T45.0X5A` — Adverse effect of antiallergic and antiemetic drugs, initial encounter

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

When reporting the JW modifier for discarded drug, the medical record must clearly show the amount administered and the amount wasted.
Medical record must document prior anthracycline therapy for patients receiving albumin-bound paclitaxel, or clearly document a clinical contraindication to anthracycline therapy.
For claims with no discarded amounts from single-dose containers or single-use packages, include the JZ modifier as evidence on the claim (effective July 1, 2023).
Document dose and frequency as consistent with the FDA label or recognized compendia for the indication (including citations to the compendia if used for off-label indications).

Paclitaxel administered intravenously is covered for antineoplastic (cancer) indications when used in accordance with the FDA-approved labeling.
Off-label uses of paclitaxel are covered when supported by recognized compendia (e.g., NCCN, AHFS, Clinical Pharmacology, Lexi-Drugs, Micromedex) and dosing/frequency follow those compendia.
Albumin-bound paclitaxel (Abraxane) is covered when prior therapy included an anthracycline unless anthracycline therapy is clinically contraindicated.
Allergy testing is covered when the medical record documents a history indicating the possible presence of allergy and the clinician selected a minimal number of tests/antigens based on patient-specific history and physician examination.
Allergy testing is covered when the medical record documents the test(s) used, the interpretation(s), and objective measurement of reaction size (wheal and erythema in mm) or a standardized in vivo grading system.
Urine drug testing (UDT) and drugs-of-abuse testing are covered when reasonable and necessary per LCD L35006 and ordered on an individual patient basis by the treating clinician with medical-record documentation of medical necessity.

A57472 — Billing and Coding: Allergy Immunotherapy

J05

L36408 — Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT)

J05

L36402 — Allergy Testing

J05

A57473 — Billing and Coding: Allergy Testing

J05

L40195 — Allergen Immunotherapy (AIT) with Subcutaneous Immunotherapy (SCIT)

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