Does 0129U require prior authorization?

No, 0129U does not require prior authorization (high confidence). Code is covered without prior authorization.

`0129U` — Gene analysis of genes associated with hereditary breast cancer and related disorders for gene sequence and duplication or deletion variants

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

The article does not specify documentation requirements; follow the documentation, medical record, and prior authorization requirements described in LCD MolDX: Repeat Germline Testing L38429 and MolDX program guidance.
This article provides billing and coding guidelines that complement the Local Coverage Determination (LCD) MolDX: Repeat Germline Testing L38288 and refers providers/claimants to LCD L38288 for detailed coverage criteria.
Claims for repeat germline testing must reference and be supported by documentation consistent with MolDX LCD L38351, including prior germline test reports and clinical rationale for repeat testing.
Follow applicable billing/coding instructions and any required forms or prior authorization processes specified by the LCD or local Medicare Administrative Contractor.

Coverage for repeat germline testing is determined by the referenced Local Coverage Determination MolDX: Repeat Germline Testing L38429; consult that LCD for specific clinical indications that constitute covered testing.
Repeat germline testing is covered when it meets the clinical and coverage criteria specified in the MolDX Local Coverage Determination L38351.
Report molecular pathology CPT codes for nucleic acid analyses to detect germline or somatic gene variants or to test for histocompatibility antigens (e.g., HLA).
Use HCPCS G0452 with modifier 26 when a pathologist performs the interpretation of a molecular pathology test.
Assign an unlisted molecular pathology CPT code 81479 if the analyte tested is not listed under Tier 2 codes and is not represented by a Tier 1 CPT code.
Report a CPT code described as “full gene sequence” only when the performed assay is a full gene sequence.

A57100 — Billing and Coding: MolDX: Repeat Germline Testing

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A58756 — Billing and Coding: MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer

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

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L39040 — MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer

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