Does 0238U require prior authorization?

No, 0238U does not require prior authorization (high confidence). Code is covered without prior authorization.

`0238U`

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.
All documentation must be maintained in the patient's medical record and be made available to the contractor upon request.
Every page of the record must be legible and include appropriate patient identification information, including complete name and dates of service.
The record must include the legible signature of the physician or non-physician practitioner responsible for and providing the patient's care.

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.
Genetic testing for Lynch syndrome is covered when the patient meets the reasonable and necessary clinical criteria specified in LCD L34912.
MMR (mismatch repair) germline mutation testing is covered when appropriate tumor screening with immunohistochemistry (IHC) or microsatellite instability (MSI) testing indicates need for germline testing.
MMR germline testing may be billed when MSI or IHC cannot be performed or yields contradictory/inconclusive results, provided the claim includes the -KX modifier and supporting documentation is on file.
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).
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.

L36807 — MolDX: Molecular Diagnostic Tests (MDT)

J05

L38429 — MolDX: Repeat Germline Testing

J05

A57100 — Billing and Coding: MolDX: Repeat Germline Testing

J05

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

J05

A59492

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