Does 0469U require prior authorization?

No, 0469U does not require prior authorization (high confidence). Code is covered without prior authorization.

`0469U`

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).
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.
Tests that demonstrate analytical validity, clinical validity, and clinical utility sufficient to meet Medicare's reasonable and necessary requirement are covered.
Tests performed for a diagnosis-specific indication or to provide results that will improve patient outcomes or change clinician management are covered when other MolDx requirements are met.
The policy applies to non‑FDA laboratory developed tests (LDTs), modified FDA‑approved/cleared kits, and tests/assays billed with more than one HIPAA‑compliant code (including NOC) that meet MolDx registration/TA and validity/utility requirements.
MolDX will cover and reimburse molecular diagnostic tests (MDTs) that have completed MolDX registration and a technical assessment (TA) and that meet Medicare's reasonable and necessary criteria for coverage.

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

J05

L36807 — MolDX: Molecular Diagnostic Tests (MDT)

J05

A56973 — Billing and Coding: MolDX: Molecular Diagnostic Tests (MDT)

A57526 — Billing and Coding: MolDX: Molecular Diagnostic Tests (MDT)

A57527 — Billing and Coding: MolDX: Molecular Diagnostic Tests (MDT)

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