Does 0434U require prior authorization?

No, 0434U does not require prior authorization (high confidence). Code is covered without prior authorization.

`0434U`

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

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

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).
Molecular diagnostic tests (MDTs) that have completed MolDx registration and technical assessment (TA) and are listed as covered by MolDx are covered when they meet Medicare's reasonable and necessary criteria.

L36807 — MolDX: Molecular Diagnostic Tests (MDT)

J05

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

J05

L39995 — Pharmacogenomic Testing

J06

A59914 — Billing and Coding: Pharmacogenomic Testing

J06

A59915 — Billing and Coding: Pharmacogenomic Testing

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