Does 0347U require prior authorization?

No, 0347U does not require prior authorization (high confidence). Code is covered without prior authorization.

`0347U`

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.
Select and report the appropriate CPT code for the Molecular Diagnostic Test service.
Enter 1 unit of service (UOS) when reporting the Molecular Diagnostic Test.
For Part B electronic 837P claims, place the appropriate DEX Z-Code identifier adjacent to the CPT code in Loop 2400 or SV101-7 in the comment/narrative field.

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.
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).
Pharmacogenomic (PGx) testing is covered when results are used to guide drug selection, dosing, or to predict adverse reactions and there is established clinical utility (e.g., CPIC- or FDA-recognized gene–drug associations).
Multi-gene panel (PGx panel) testing may be considered medically reasonable and necessary when multiple pharmacogenomic genes are clinically indicated for the beneficiary, even if some panel genes are not immediately relevant to current medications.
Germline testing panels that include some genetic content already tested in the same beneficiary may be covered if the remaining, non-duplicative genetic components have established clinical utility for current or future therapeutic decisions.
Serial (reflex) testing is covered when additional gene analyses are medically reasonable and necessary based on prior results (i.e., reflexive decisions make further testing necessary).

A57100 — Billing and Coding: MolDX: Repeat Germline Testing

J05

L36807 — MolDX: Molecular Diagnostic Tests (MDT)

J05

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

J05

L38429 — MolDX: Repeat Germline Testing

J05

A59915

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