Does 0047U require prior authorization?

No, 0047U does not require prior authorization (high confidence). Code is covered without prior authorization.

`0047U` — Mrna gene analysis of 17 genes in prostate tumor tissue

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Report the applicable CPT® code for the prostate genomic classifier assay on the claim.
Enter 1 unit of service (UOS) when reporting the assay.
For Part B (professional) claims, enter the appropriate DEX Z-Code™ identifier adjacent to the CPT code in the comment/narrative field: Loop 2400 or SV101-7 for 837P 5010A1 electronic claims, or Box 19 for paper claims.
For Part A (facility) claims, enter the appropriate DEX Z-Code™ identifier adjacent to the CPT code in the comment/narrative field: Line SV202-7 for 837I electronic claims or Block 80 for the UB-04 claim form.

Prostate genomic classifier assay is for men with localized prostate cancer and should be billed with diagnosis code ICD-10-CM C61 (malignant neoplasm of prostate).
Male patient with localized prostate cancer, diagnosis coded as ICD-10-CM C61, for whom a Prostate Cancer Genomic Classifier assay is being reported.
To report a Molecular Diagnostic Test (MDT) service, submit the appropriate CPT code, include the appropriate DEX Z-Code identifier adjacent to the CPT code in the claim comment/narrative field, and enter 1 unit of service (UOS).
A molecular or genomic test may be covered when it provides new clinical diagnostic information that cannot be obtained from any other test or combination of tests and is reasonable and necessary for management of the Medicare beneficiary.
A molecular panel is coverable when the medical record documents that the entire panel is reasonable and necessary for the beneficiary’s specific medical problem and will be used in patient management.
Individual gene tests billed separately are coverable when the medical record documents that each individual gene test is reasonable and necessary for the beneficiary’s management.

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

J05

L36807 — MolDX: Molecular Diagnostic Tests (MDT)

J05

A57106 — Billing and Coding: MolDX: Prostate Cancer Genomic Classifier Assay for Men with Localized Disease

J05

L38433 — MolDX: Prostate Cancer Genomic Classifier Assay for Men with Localized Disease

J05

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