Does 0158U require prior authorization?

No, 0158U does not require prior authorization (high confidence). Code is covered without prior authorization.

`0158U`

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, coding, and related guidelines that complement the Local Coverage Determination (LCD) MolDX: Repeat Germline Testing L38353 and does not by itself define clinical coverage criteria.
Maintain all documentation in the patient's medical record and make it available to the contractor upon request.
Every page of the record must be legible and include appropriate patient identification information (e.g., full name, dates of service).

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.
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.
Code selection should be based on the specific gene(s) analyzed and include all variants tested within the labelled CPT code (additional variants tested are included and not reported separately unless otherwise specified).

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

J05

L36807 — MolDX: Molecular Diagnostic Tests (MDT)

J05

A57100 — Billing and Coding: MolDX: Repeat Germline Testing

J05

L38429 — MolDX: Repeat Germline Testing

J05

A58918

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