Does 0040U require prior authorization?

No, 0040U does not require prior authorization (high confidence). Code is covered without prior authorization.

`0040U`

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Labs may submit the required DEX Z-Code information using SV101-7, SV202-7 (preferred), or the NTE field when available.
Include the appropriate DEX Z-Code identifier adjacent to the CPT code in the claim comment/narrative field for all applicable submissions.
For Part B electronic 837P submit the DEX Z-Code in Loop 2400 or SV101-7; for Part B paper claims enter it in Box 19.
For Part A electronic 837I submit the DEX Z-Code on line SV202-7; for UB04 paper claims enter it in Block 80.

Report multiple BCR-ABL breakpoint tests assigned a single test ID using CPT 81479 (one unit of service) when tests are performed as a panel or combination.
Report FDA-approved MRDx BCR-ABL Test using CPT 0040U.
Report ABL1 Kinase Domain Mutation Analysis for acquired tyrosine kinase inhibitor resistance using CPT 81170 with one unit of service and the assigned DEX Z-code.
When performing BCR-ABL translocation analysis by next-generation sequencing (NGS), submit CPT 81479 with one unit of service and the assigned DEX Z-code.
The CPT code combinations 81206+81207 and 81206+81207+81208 are recognized when performed as specified combinations.
When breakpoint testing for BCR-ABL1 is performed as a combination or panel (major, minor, other breakpoints), report multiple tests assigned a single MolDX test ID using CPT 81479.

A57772 — Billing and Coding: MolDX: Molecular Diagnostic Tests (MDT)

J05

L38835 — MolDX: Minimal Residual Disease Testing for Cancer

J05

A55233 — Billing and Coding: MolDx: BCR-ABL

J05

L40022 — MolDX: Non-Next Generation Sequencing Tests for the Diagnosis of BCR-ABL Negative Myeloproliferative Neoplasms

J05

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