Does 0155U require prior authorization?

No, 0155U does not require prior authorization (high confidence). Code is covered without prior authorization.

`0155U`

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Submit the appropriate CPT code for the PIK3CA targeted gene sequencing service and select the appropriate diagnosis for the patient on the claim.
Include the DEX Z-Code™ identifier adjacent to the CPT code in the comment/narrative field for Part B claims (Loop 2400 or SV101-7 for 837P; Box 19 for paper claims).
Include the DEX Z-Code™ identifier adjacent to the CPT code in the comment/narrative field for Part A claims (Line SV202-7 for 837I electronic claims; Block 80 for UB04 claim form).
Submit the appropriate CPT code for the PIK3CA targeted sequencing service.

PIK3CA targeted gene sequencing is covered when performed to detect PIK3CA mutations in patients who are postmenopausal women or men with hormone receptor (HR)-positive, HER2-negative advanced or metastatic breast cancer following progression on or after an endocrine-based regimen.
Covered tests must be FDA-approved tests for detecting PIK3CA mutations when used to identify patients eligible for alpelisib (Piqray) therapy.
PIK3CA targeted gene sequencing is covered for postmenopausal women and men with hormone receptor (HR)-positive, HER2-negative, advanced or metastatic breast cancer who have a PIK3CA mutation and have progressed on or after an endocrine-based regimen.
PIK3CA targeted gene sequencing is indicated to detect PIK3CA mutations in patients with hormone receptor (HR)-positive, HER2-negative, advanced or metastatic breast cancer (postmenopausal women and men) who have progressed on or after an endocrine-based regimen when results will inform treatment with alpelisib (Piqray).
PIK3CA targeted gene sequencing is covered to detect PIK3CA mutations in postmenopausal women and men with hormone receptor (HR)-positive, HER2-negative advanced or metastatic breast cancer who have progressed on or after an endocrine-based regimen to determine eligibility for alpelisib (Piqray).
The test must be an FDA-approved PIK3CA diagnostic test when used to identify patients for treatment with FDA-approved alpelisib (Piqray).

L36807 — MolDX: Molecular Diagnostic Tests (MDT)

J05

A55200 — Billing and Coding: MolDX: PIK3CA Gene Tests

J05

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

J05

L39367 — Genetic Testing in Oncology: Specific Tests

J09

A58918

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