Does 0509U require prior authorization?

No, 0509U does not require prior authorization (high confidence). Code is covered without prior authorization.

`0509U`

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

For Part A UB04 paper claim forms, enter the DEX Z-Code adjacent to the CPT code in Block 80.
For Part B electronic 5010A1 837P claims, enter the DEX Z-Code adjacent to the CPT code in Loop 2400 or SV101-7.
For Part B paper claims, enter the DEX Z-Code adjacent to the CPT code in Box 19 of the paper claim form.
For Part A electronic 837I claims, enter the DEX Z-Code adjacent to the CPT code on line SV202-7.

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.

L40248 — MolDX: Molecular Testing for Solid Organ Allograft Rejection

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

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

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A60273 — 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.