Z94.9 — Transplanted organ and tissue status, unspecified
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Claims must report the appropriate CPT code for the flow cytometry service, include 1 unit of service (UOS), and list the appropriate ICD-10-CM diagnosis code.
- Medical necessity documentation per LCD L34513 is required when coverage criteria are not fully met in this billing guideline (for example, when >24 markers are requested).
- The patient's medical record must include the assessment by the ordering provider as it relates to the patient's complaint for that visit.
- The medical record must include relevant medical history and results of pertinent tests/procedures.
Key Coverage Criteria
- Coverage and medical necessity determinations for flow cytometry are governed by Local Coverage Determination L34513.
- Flow cytometry may be used to analyze cellular components of body fluids and lymphoreticular tissues, including peripheral blood, cerebrospinal fluid (CSF), bone marrow, lymph nodes, tonsil, spleen, and fine needle aspirate material.
- Peripheral blood or fine needle aspirate specimens may be used to avoid more invasive diagnostic procedures when clinically appropriate.
- Flow cytometry is covered for examination of body fluids (including peripheral blood and cerebrospinal fluid), bone marrow, and lymphoreticular tissues (lymph nodes, tonsil, spleen).
- Peripheral blood and fine needle aspirate specimens are acceptable for flow cytometry to avoid more invasive diagnostic procedures.
- Coverage decisions are governed by the associated Local Coverage Determination LCD L34215 and its specific coverage criteria.
11 Active Policies
A57690 — Billing and Coding: Lab: Flow Cytometry
AETNA-CPB-0351 — Flow Cytometry, Ektacytometry, DNA Ploidy, and S-phase Fraction
AETNA-CPB-0638 — Donor Lymphocyte Infusion
ANTHEM-CG-LAB-14 — CG-LAB-14 Respiratory Viral Panel Testing in the Outpatient Setting
ANTHEM-CG-SURG-90 — CG-SURG-90 Mohs Micrographic Surgery
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