Does 0221U require prior authorization?

No, 0221U does not require prior authorization (high confidence). Code is covered without prior authorization.

`0221U`

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.
Select and report the appropriate CPT or PLA code for the blood product molecular antigen typing service and enter the unit of service (UOS) on the claim.
For Part B claims, enter the appropriate DEX Z-Code identifier adjacent to the CPT/PLA code in the comment/narrative field: use Loop 2400 or SV101-7 for 5010A1 837P electronic claims or Box 19 for paper claims.
For Part A claims, enter the appropriate DEX Z-Code identifier adjacent to the CPT/PLA code in the comment/narrative field: use Line SV202-7 for 837I electronic claims or Block 80 for the UB04 claim form.

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.
MolDX blood product molecular antigen typing panels 0001U and 0084U (germline tests) are covered for beneficiaries but are limited to one test per beneficiary lifetime.
To report a Molecular Diagnostic Test (MDT) service, submit the appropriate CPT code, include the appropriate DEX Z-Code identifier adjacent to the CPT code in the claim comment/narrative field, and enter 1 unit of service (UOS).
Panel codes 0001U and 0084U for blood product molecular antigen typing are covered when billed as a panel.
Blood product molecular antigen typing services consistent with the Local Coverage Determination L38240 are eligible for coverage (clinical criteria per LCD L38240).
A molecular or genomic test may be covered when it provides new clinical diagnostic information that cannot be obtained from any other test or combination of tests and is reasonable and necessary for management of the Medicare beneficiary.

A57110 — Billing and Coding: MolDX: Blood Product Molecular Antigen Typing

J05

L38429 — MolDX: Repeat Germline Testing

J05

L38441 — MolDX: Blood Product Molecular Antigen Typing

J05

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

J05

A57100

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