Does 0225U require prior authorization?

No, 0225U does not require prior authorization (high confidence). Code is covered without prior authorization.

`0225U`

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Select and report the appropriate CPT code for the Molecular Diagnostic Test service.
Enter 1 unit of service (UOS) when reporting the Molecular Diagnostic Test.
For Part B electronic 837P claims, place the appropriate DEX Z-Code identifier adjacent to the CPT code in Loop 2400 or SV101-7 in the comment/narrative field.
For Part B paper claims, enter the appropriate DEX Z-Code identifier adjacent to the CPT code in Item 19.

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).
Respiratory pathogen panel testing is covered when performed in an outpatient, non-institutional Part B setting from a single biologic specimen on a single date of service and the order is not a reflex test.
Respiratory pathogen panel testing is covered when the medical record documents that the testing facility can deliver timely results and that the test results can reasonably be expected to change clinical management and improve patient health outcomes.
Respiratory pathogen panel testing is covered when performed as a single service from a single biologic specimen in the outpatient setting on a single date of service and is reasonable and necessary per LCD L38918.
The test is covered when performed in a Medicare Part B setting that is equipped to deliver timely results and when the results can reasonably be expected to lead to a change in clinical management that improves health outcomes.
Molecular syndromic infectious disease panels are covered when billed with the appropriate proprietary CPT®/PLA code (or CPT® 87999 if no specific code exists) and accompanied by ICD-10-CM diagnosis codes that support medical necessity documented in the patient record.

L39044 — MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

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L36807 — MolDX: Molecular Diagnostic Tests (MDT)

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A58761 — Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

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

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