Does 0003U require prior authorization?

No, 0003U does not require prior authorization (high confidence). Code is covered without prior authorization.

`0003U`

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

The diagnosis code(s) billed must best describe the patient's condition for which the multimarker serum test was performed.
For diagnostic tests, report the test result on the claim if known; if the result is not known at time of billing, report the symptoms that prompted performance of the test.
When required, report the referring/ordering physician's name and NPI on the claim.
Use the following CPT codes when billing: CPT 81500 for ROMA, CPT 81503 for OVA1, and CPT 0003U for OVERA.

Multimarker serum tests related to the evaluation or monitoring of ovarian cancer may be billed under this policy in accordance with the applicable Local Coverage Determination (LCD).
A test is considered a proteomics test if it is a multianalyte assay that includes proteins as the major or essential analytes.
A test is considered proteomics if it measures the interactions between analytes, including proteins.
A test is considered proteomics if it requires informatics (e.g., nomograms, rubrics, or algorithms) to produce a result.
A test is considered proteomics if the assay demonstrates clinical validity as a function of the interactions among the analytes measured.
Test is a multianalyte assay that includes proteins as the major or essential analytes.

L36807 — MolDX: Molecular Diagnostic Tests (MDT)

J05

A59649 — Billing and Coding: MolDX: Proteomics Testing

J05

L38371 — Multimarker Serum Tests Related to Ovarian Cancer Testing

J06

A57020 — Billing and Coding: Multimarker Serum Tests Related to Ovarian Cancer Testing

J06

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