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.
Performing providers must acquire and retain medical records documenting the drug(s) under consideration or in current use that necessitate the ordered pharmacogenomic test.
If MolDX technical assessment or test-specific forms are available for the test type, those forms are required to support coverage determinations and must be submitted per MolDX instructions.
Claims must include: appropriate CPT® or PLA code, exactly 1 unit of service (UOS), the appropriate DEX Z-Code® identifier adjacent to the CPT/PLA code in the required comment/narrative field, and an appropriate ICD-10-CM diagnosis code.

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.
CYP2C9 and VKORC1 pharmacogenomic testing for warfarin dosing is covered when performed in accordance with NCD 90.1.
Pharmacogenomic tests (single-gene or multigene) that correspond to gene–drug associations identified by CPIC or FDA (see Table 1 and Table 2) are billable when the test will inform therapy for the drug(s) being considered or currently used by the beneficiary.
When no specific CPT code exists for a tested gene, the unlisted molecular pathology code 81479 (NOC) may be used per the test application/billing process.
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.

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

J05

L36807 — MolDX: Molecular Diagnostic Tests (MDT)

J05

L38435 — MolDX: Pharmacogenomics Testing

J05

A57100 — Billing and Coding: MolDX: Repeat Germline Testing

J05

A58395

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