Does 0508U require prior authorization?

No, 0508U does not require prior authorization (high confidence). Code is covered without prior authorization.

`0508U`

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Select and report the appropriate CPT code for the Molecular Diagnostic Test service.
Enter 1 unit of service (UOS) when reporting the Molecular Diagnostic Test.
For Part B electronic 837P claims, place the appropriate DEX Z-Code identifier adjacent to the CPT code in Loop 2400 or SV101-7 in the comment/narrative field.
For Part B paper claims, enter the appropriate DEX Z-Code identifier adjacent to the CPT code in Item 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 testing for solid organ allograft rejection is covered when the specific test and clinical use meet the coverage criteria of LCD L38568.
AlloMap (CareDX) GEP on blood is covered for heart transplant recipients when used per LCD L38568 to assess immune quiescence and probability of acute rejection.
AlloSure (CareDX) NGS dd-cfDNA on blood is covered for kidney, heart, and lung transplant recipients when used per LCD L38568 to detect graft injury and probability of acute rejection.
HeartCare (CareDX) (AlloSure Heart + AlloMap Heart performed on same sample) is covered for heart transplant recipients when both tests are ordered and billed per LCD L38568.
Prospera (Natera) mmPCR-NGS % dd-cfDNA on blood is covered for kidney, heart, and lung transplant recipients when used per LCD L38568 to identify graft injury and acute rejection.

L36807 — MolDX: Molecular Diagnostic Tests (MDT)

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

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L40248 — MolDX: Molecular Testing for Solid Organ Allograft Rejection

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A58207 — Billing and Coding: MolDX: Molecular Testing for Solid Organ Allograft Rejection

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