Does 81479 require prior authorization?

No, 81479 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 81479?

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

An Advance Beneficiary Notice (ABN) is not required for statutorily excluded services; if a voluntary ABN is issued, append the GX modifier.
To indicate a statutorily excluded service on the claim, append the GY modifier to the applicable CPT code.
Enter the DEX Z-Code™ identifier adjacent to the CPT code in the claim comment/narrative for Part B: Loop 2400 or SV101-7 for 5010A1 837P electronic claims, or Box 19 for paper claims.
Enter the DEX Z-Code™ identifier adjacent to the CPT code for Part A claims: Line SV202-7 for 837I electronic claims, or Block 80 for the UB04 claim form.

therascreen® KRAS test: detection of somatic KRAS mutations to identify colorectal cancer (CRC) patients for treatment with cetuximab (Erbitux®).
cobas® KRAS test: detection of KRAS mutations in codons 12 and 13 to identify colorectal cancer (CRC) patients for treatment with cetuximab (Erbitux®) or panitumumab (Vectibix®).
MammaPrint® is indicated to analyze gene expression of FFPE breast cancer tissue to assess a patient's risk for distant metastasis (early-stage breast cancer).
The test may be performed using either the FDA-cleared microarray assay or a next-generation sequencing (NGS)-based assay.
Germline testing is covered when the patient has ovarian, breast, pancreatic, or prostate cancer and meets clinical indication for immediate treatment with an FDA‑approved PARP inhibitor.
Testing for deleterious variants in homologous recombination repair (HRR) genes (e.g., BRCA1, BRCA2) is covered as an aid when results will be used to determine eligibility for PARP inhibitor therapy.

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