0337U — Evaluation of plasma cells for detection of abnormalities associated with plasma cell disorders and myeloma
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Clinical documentation that tumor tissue testing is not feasible or that a clinical/tissue biopsy cannot be obtained.
- Clinical documentation that the patient cannot safely undergo tissue biopsy (notes, risk assessment).
- Documentation of suspected or proven metastatic adenocarcinoma when ordering broad molecular profiling.
- Documentation of prior targeted therapy when requesting repeat molecular testing to guide further treatment.
Key Coverage Criteria
- EGFR T790M mutation testing via ctDNA for patients with lung cancer (ICD-10-CM C34).
- Persistent or recurrent cervical cancer
- Unresectable or metastatic biliary tract cancer
- Suspected or confirmed histiocytic neoplasm.
- Locoregional unresectable or metastatic extrapulmonary poorly differentiated neuroendocrine carcinoma.
- Locoregional unresectable or metastatic large cell or small cell carcinoma.
1 Active Policy
AMBETTER-CG-Onc-Liquid-Biopsy-2025.1 — Concert Genetic Oncology: Circulating Tumor Cells (Liquid Biopsy)
Related Codes
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