Does 81439 require prior authorization?

No, 81439 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 81439?

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

Do not require an Advance Beneficiary Notice (ABN) for statutorily excluded ARVD/C tests; if a voluntary ABN is issued append modifier GX to the claim.
To indicate a statutorily excluded service on the claim append modifier GY to the service line.
Submit the appropriate diagnosis code for the patient on the claim (select the applicable ICD-10 code for ARVD/C or related diagnosis).
Include the required lab billing information using either SV101-7 or SV202-7 (preferred) or the NTE field when submitting the claim.

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.
When 51 or more genes are ordered for molecular biomarkers, bill the appropriate large-panel CPT code (81455 or 81456) rather than individual gene codes.
When a panel contains more than one but fewer than five genes, use the corresponding existing panel CPT code or CPT 81479 (unlisted molecular pathology procedure) if no specific panel CPT exists.
Use modifier 91 only when a test is performed more than once on the same day for the same patient and the repeat testing is necessary to obtain multiple results in the course of treatment.
Coverage for repeat germline testing is determined by the referenced Local Coverage Determination MolDX: Repeat Germline Testing L38429; consult that LCD for specific clinical indications that constitute covered testing.
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).

A57100 — Billing and Coding: MolDX: Repeat Germline Testing

J05

L36523 — MolDX: Biomarkers in Cardiovascular Risk Assessment

J05

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

J05

L38429 — MolDX: Repeat Germline Testing

J05

A55235

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