Does 81207 require prior authorization?

No, 81207 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 81207?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Labs may submit the required DEX Z-Code information using SV101-7, SV202-7 (preferred), or the NTE field when available.
Include the appropriate DEX Z-Code identifier adjacent to the CPT code in the claim comment/narrative field for all applicable submissions.
For Part B electronic 837P submit the DEX Z-Code in Loop 2400 or SV101-7; for Part B paper claims enter it in Box 19.
For Part A electronic 837I submit the DEX Z-Code on line SV202-7; for UB04 paper claims enter it in Block 80.

Report multiple BCR-ABL breakpoint tests assigned a single test ID using CPT 81479 (one unit of service) when tests are performed as a panel or combination.
Report FDA-approved MRDx BCR-ABL Test using CPT 0040U.
Report ABL1 Kinase Domain Mutation Analysis for acquired tyrosine kinase inhibitor resistance using CPT 81170 with one unit of service and the assigned DEX Z-code.
When performing BCR-ABL translocation analysis by next-generation sequencing (NGS), submit CPT 81479 with one unit of service and the assigned DEX Z-code.
The CPT code combinations 81206+81207 and 81206+81207+81208 are recognized when performed as specified combinations.
When a molecular panel of 5–50 genes is ordered, bill the appropriate panel CPT code (81445, 81449, 81450, or 81451) instead of submitting individual single-gene CPT codes.

A59938 — Billing and Coding: Non-Next Generation Sequencing Tests for the Diagnosis of BCR-ABL Negative Myeloproliferative Neoplasms

J05

L38835 — MolDX: Minimal Residual Disease Testing for Cancer

J05

L40021 — MolDX: Non-Next Generation Sequencing Tests for the Diagnosis of BCR-ABL Negative Myeloproliferative Neoplasms

J05

A59004 — Billing and Coding: MolDX: Minimal Residual Disease Testing for Hematologic Cancers

J05

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