Does 0077U require prior authorization?

No, 0077U does not require prior authorization (high confidence). Code is covered without prior authorization.

`0077U` — Detection of immunoglobulin paraprotein (m-protein) in blood or urine

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medical records must document that applicable LCD coverage criteria are met and that the test is expected to influence treatment; include relevant history, exam findings, problems/diagnoses, and data (labs, imaging) that support the ordering decision.
The laboratory or billing provider must retain the physician requisition that specifies the diagnosis or condition (ICD-10-CM code) warranting the test.
Performing laboratories must have, and provide when requested, documentation such as lab accreditation, test requisition, test records/procedures, preliminary and final reports, and quality control records.
For laboratory-developed tests (LDTs) or protocols, documentation when requested must include the diagnostic assay, laboratory/manufacturer, names of comparable assays (if relevant), assay description, analytical validity, clinical validity, and clinical utility evidence.

MS testing is covered when performed in accordance with the applicable Local Coverage Determination (LCD) coverage guidelines for monoclonal gammopathy.
Mass spectrometry (MS) testing is covered when the medical record documents that the testing is expected to influence the treatment or management of the condition for which the test is ordered.
Serum mass spectrometry (MS), with concurrent serum or urine immunofixation electrophoresis (sIFE/uIFE), is covered to confirm initial detection of M-protein when there is an abnormal serum protein electrophoresis (SPEP) or abnormal serum free light-chain (sFLC) test.
Serum MS, with concurrent sIFE/uIFE, is covered to discriminate therapeutic monoclonal antibody(s) from endogenous M-protein(s) during patient monitoring.
Serum MS, with concurrent sIFE/uIFE, is covered for assessment of treatment response when performed in accordance with accepted clinical guidelines.

A58921 — Billing and Coding: Mass Spectrometry (MS) Testing in Monoclonal Gammopathy (MG)

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L39189 — Mass Spectrometry (MS) Testing in Monoclonal Gammopathy (MG)

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