Z52.20 — Bone donor, unspecified
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Documentation that the patient with advanced cancer meets the clinical indication for somatic genomic profiling (diagnosis/stage/clinical context).
- Documentation that the provider informed the patient, prior to somatic testing, of the potential to uncover incidental germline findings.
- Documentation that treatment decisions are based on clinically validated/actionable variants (not VUS) and, when applicable, results of confirmatory germline testing for suspected hereditary variants.
- Submit an ICD-10 diagnosis code on the claim that corresponds to the panel indication (e.g., C34 for lung, C18-C20 for colorectal).
Key Coverage Criteria
- Glioma — diagnosis or undergoing workup
- Histiocytosis — diagnosis or undergoing workup
- Sarcoma — diagnosis or undergoing workup
- NPM1 (MRD) testing for myeloid leukemia monitoring (ICD: C92).
- Gastrointestinal stromal tumor (GIST) when the tumor is negative for KIT and PDGFRA somatic mutations
- Advanced (stage IIIb or higher) or metastatic squamous cell lung carcinoma
1 Active Policy
AMBETTER-CG-Onc-Tumor-Hemat.-Malig.-2025.1 — Concert Genetic Oncology: Molecular Analysis of Solid Tumors and Hematologic Malignancies
Related Codes
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