Does 0345U require prior authorization?

No, 0345U does not require prior authorization (high confidence). Code is covered without prior authorization.

`0345U` — Genomic analysis panel of 15 genes for detection of abnormalities assocated with mental health disorders

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.
This article provides billing and coding guidelines that complement the Local Coverage Determination (LCD) MolDX: Repeat Germline Testing L38288 and refers providers/claimants to LCD L38288 for detailed coverage criteria.
Performing providers must acquire and retain medical records showing the drug or drugs under consideration or in use by the ordering physician that necessitate the PGx test.
Claims must report the appropriate CPT or PLA code with 1 unit of service and include the applicable DEX Z-Code identifier adjacent to the CPT/PLA code in the specified claim comment/narrative fields.

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.
Pharmacogenomic (PGx) testing is covered when the test is ordered to guide therapy for a specific drug or drugs under consideration and when the drug(s) have established gene/drug associations documented by CPIC or FDA guidance.
Testing of CYP2C9 and VKORC1 for warfarin dosing is covered only when requirements of NCD 90.1 are met and the testing adheres to that NCD's specified clinical criteria and documentation.
Single-gene tests or multigene panels are covered when the selected test is the single most likely to identify the alleles/variants necessary for clinical decision-making for the drug(s) in question.
When no specific CPT code exists for the gene tested, testing may be billed using the unlisted molecular pathology code 81479.
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).

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

J05

L36807 — MolDX: Molecular Diagnostic Tests (MDT)

J05

A57100 — Billing and Coding: MolDX: Repeat Germline Testing

J05

L38429 — MolDX: Repeat Germline Testing

J05

A58395

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