0435U
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- If a voluntary ABN is issued, append the GX modifier to the CPT code on the claim.
- To indicate a statutorily excluded service on the claim, append the GY modifier to the CPT code.
- To receive a CSRA denial, the claim must include the applicable CPT code(s) for the assay on the claim.
- An Advance Beneficiary Notice (ABN) is not required for statutorily excluded services.
Key Coverage Criteria
- Coverage and medical necessity determinations for in vitro chemosensitivity and chemoresistance assays follow the Local Coverage Determination L34554.
3 Active Policies
A56871 — Billing and Coding: In Vitro Chemosensitivity & Chemoresistance Assays
L34554 — In Vitro Chemosensitivity & Chemoresistance Assays
REGENCE-LAB06 — In Vitro Chemoresistance and Chemosensitivity Assays
Related Codes
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