Does 0540U require prior authorization?

No, 0540U does not require prior authorization (high confidence). Code is covered without prior authorization.

`0540U`

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).
AlloMap (CareDx) is covered for heart transplant recipients when billed in accordance with the coverage criteria of LCD L38629.
AlloSure (CareDx) is covered for kidney, heart, and lung transplant recipients when billed in accordance with the coverage criteria of LCD L38629.
HeartCare (CareDx) (AlloSure Heart + AlloMap Heart on same sample) is covered for heart transplant recipients when billed per LCD L38629.
Prospera (Natera) is covered for kidney, heart, and lung transplant recipients when billed in accordance with the coverage criteria of LCD L38629.
QSant (NephroSant) is covered for kidney transplant recipients when billed in accordance with the coverage criteria of LCD L38629.

L36807 — 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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L38680 — MolDx: Molecular Testing for Solid Organ Allograft Rejection

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