Does 0388U require prior authorization?

No, 0388U does not require prior authorization (high confidence). Code is covered without prior authorization.

`0388U` — Onc nonsm cll lng ca 37 gen

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Report the InvisionFirst®–Lung service using CPT code 81479 on the claim.
Enter 1 unit of service (UOS) for CPT 81479 on the claim.
For Part B electronic claims (5010A1 837P), place the appropriate DEX Z‑Code identifier adjacent to the CPT code in Loop 2400 or SV101-7.
For Part B paper claims, enter the appropriate DEX Z‑Code identifier in Box 19 adjacent to the CPT code.

InvisionFirst®–Lung liquid biopsy for patients with lung cancer as covered per MolDX Local Coverage Determination L37921.
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.
Individual gene tests billed separately are coverable when the medical record documents that each individual gene test is reasonable and necessary for the beneficiary’s management.
When using next generation sequencing (NGS), genes assayed in parallel for the same indication on the same date of service are considered a single panel and may be billed as such when reasonable and necessary.

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

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A56333 — Billing and Coding: MolDX: Inivata, InVisionFirst, Liquid Biopsy for Patients with Lung Cancer

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L36807 — MolDX: Molecular Diagnostic Tests (MDT)

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L37921 — MolDX: Inivata, InVisionFirst, Liquid Biopsy for Patients with Lung Cancer

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