Does 0250U require prior authorization?

No, 0250U does not require prior authorization (high confidence). Code is covered without prior authorization.

`0250U` — Gene analysis of 505 genes associated with solid organ cancer in tumor tissue sample, targeted genomic sequence interrogation for somatic alterations, microsatellite instability and tumor-mutation burden

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

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

Coverage is allowed for targeted genomic sequence analysis panels for treatment of solid organ neoplasms when the panel is a DNA analysis panel containing at least 5 gene tests for molecular biomarkers that meet Medicare coverage criteria.
Coverage is allowed when the genomic testing is expected to influence the treatment of the condition (i.e., documentation supports that test results will affect clinical management of the solid organ neoplasm).
Genomic testing of acquired conditions such as malignancies, including separate malignancies developing at different times, is permitted when medically reasonable and necessary to assess response or other clinically relevant criteria.
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.
A molecular panel is coverable when the medical record documents that the entire panel is reasonable and necessary for the beneficiary’s specific medical problem and will be used in patient management.

A57858 — Billing and Coding: MolDX: Next-Generation Sequencing for Solid Tumors

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

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L38158 — MolDX: Next-Generation Sequencing for Solid Tumors

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L36807 — MolDX: Molecular Diagnostic Tests (MDT)

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