Does 0080U require prior authorization?

No, 0080U does not require prior authorization (high confidence). Code is covered without prior authorization.

`0080U` — Analysis of galectin-3-binding protein and scavenger receptor cysteine-rich type 1 protein m130 in plasma, with clinical risk factors, to evaluate probability of lung cancer

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

The document provides billing, coding, and other guidelines that complement LCD BDX-XL2 (L37031); claims should follow the LCD and any prior authorization or documentation requirements specified by that LCD.
This article contains billing, coding, or other guidelines that complement the Local Coverage Determination (LCD) for BDX-XL2 (HCPCS L37216); consult LCD L37216 for clinical coverage criteria.
All proteomics tests in MolDX jurisdictions must register with the DEX Diagnostics Exchange Registry and obtain a DEX Z‑Code identifier prior to submission.
Proteomics tests will undergo Technical Assessment by Palmetto GBA as part of the MolDX program.

Test is considered a proteomics test if it is a multianalyte assay in which proteins are the major or essential analytes measured.
Test is considered a proteomics test if it measures interactions between analytes, including protein–protein or protein–other analyte interactions.
Test is considered a proteomics test if the analytic process requires the use of informatics (e.g., nomograms, rubrics, or algorithms) to generate the reported result.
Test is considered a proteomics test if the clinical validity of the assay is demonstrated as a function of the interactions of analytes measured (i.e., validity depends on analyte interactions, not single analyte presence alone).
MolDX will cover and reimburse molecular diagnostic tests (MDTs) that have completed MolDX registration and a technical assessment (TA) and that meet Medicare's reasonable and necessary criteria for coverage.
MolDX will cover only tests that demonstrate analytical validity, clinical validity, and clinical utility at a level that satisfies Medicare reasonable and necessary requirements.

L37216 — BDX-XL2

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A57558 — Billing and Coding: BDX-XL2

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A59649 — Billing and Coding: MolDX: Proteomics Testing

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L36807 — MolDX: Molecular Diagnostic Tests (MDT)

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CGS-L36021 — MolDX: Molecular Diagnostic Tests (MDT)

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