Does 0407U require prior authorization?

No, 0407U does not require prior authorization (high confidence). Code is covered without prior authorization.

`0407U`

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

For services requiring a referring/ordering physician, the referring/ordering physician's name and NPI must be reported on the claim.
The submitted ICD-10-CM diagnosis code(s) must best describe the patient's condition for which the test was performed.
Report PLA code 0105U for services rendered from 2024-04-01 through 2024-06-30 and report PLS code 0407U for services rendered on or after 2024-07-01.
Follow applicable NCCI and OPPS billing requirements prior to billing Medicare for these services.

KidneyIntelX or KidneyIntelX.dkd testing is covered when all criteria in the applicable LCD's Indications of Coverage are met.
A test is considered a proteomics test if it is a multianalyte assay that includes proteins as the major or essential analytes.
A test is considered proteomics if it measures the interactions between analytes, including proteins.
A test is considered proteomics if it requires informatics (e.g., nomograms, rubrics, or algorithms) to produce a result.
A test is considered proteomics if the assay demonstrates clinical validity as a function of the interactions among the analytes measured.
Test is a multianalyte assay that includes proteins as the major or essential analytes.

A59649 — Billing and Coding: MolDX: Proteomics Testing

J05

L36807 — MolDX: Molecular Diagnostic Tests (MDT)

J05

A59595 — Billing and Coding: KidneyIntelX and KidneyIntelX.dkd Testing

J06

L39726 — KidneyIntelX and KidneyIntelX.dkd Testing

J06

CGS-L36021

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