Does 0419U require prior authorization?

No, 0419U does not require prior authorization (high confidence). Code is covered without prior authorization.

`0419U`

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Report the appropriate CPT code for the Molecular Diagnostic Test on the claim.
Enter 1 unit of service (UOS) for the Molecular Diagnostic Test line item on the claim.
For Part B electronic 837P claims, place the appropriate DEX Z-Code identifier adjacent to the CPT code in Loop 2400 or in the SV101-7 comment/narrative field.
For Part B paper claims, place the appropriate DEX Z-Code identifier adjacent to the CPT code in Box 19.

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.
Repeat germline testing is covered when it meets the clinical and coverage criteria specified in the MolDX Local Coverage Determination L38351.
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).
Pharmacogenomics (PGx) testing is covered when ordered to guide drug selection or dosing for specific drug(s) that are under consideration or in use by the ordering physician and when results will inform clinical management.
CYP2C9 and VKORC1 testing for warfarin dosing is covered only in accordance with the requirements of NCD 90.1.
When MolDX Technical Assessment (TA) forms relevant to the test type are available, completion and submission of those forms are required for successful coverage determinations.

A57100 — Billing and Coding: MolDX: Repeat Germline Testing

J05

L38429 — MolDX: Repeat Germline Testing

J05

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

J05

A58395 — Billing and Coding: MolDX: Pharmacogenomics Testing

J05

L38435

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