Does 0468U require prior authorization?

No, 0468U does not require prior authorization (high confidence). Code is covered without prior authorization.

Verity

`0468U`

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Documentation Required

Bill proteomics tests with an appropriate CPT code from the Multianalyte CPT code set, the NOC code 81599, or an applicable PLA code.
Report 1 unit of service (UOS) for the proteomics CPT code on the claim.
Enter the appropriate DEX Z‑Code identifier adjacent to the CPT code in the comment/narrative field for Part B claims: Loop 2400 or SV101‑7 for the 837P electronic claim and Box 19 for paper claims.
Enter the appropriate DEX Z‑Code identifier adjacent to the CPT code in the comment/narrative field for Part A claims: Line SV202‑7 for the 837I electronic claim and Block 80 for the UB‑04 form.

Key Coverage Criteria

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.
Test measures the interactions between analytes, including protein–protein or protein–other-analyte interactions.

18 Active Policies

A59649 — Billing and Coding: MolDX: Proteomics Testing

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A60305 — Billing and Coding: MolDX: Biomarker Testing for Risk Stratification in Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis

J05

L36807 — MolDX: Molecular Diagnostic Tests (MDT)

J05

L40271 — MolDX: Biomarker Testing for Risk Stratification in Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis

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0468U