Does 82378 require prior authorization?

No, 82378 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 82378?

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

CEA testing is consideredmedically necessaryforeitherclinical scenario (AorB)andthe following conditions (C):As part of initial evaluation for suspected or diagnosed disease;orTo determine whether residual tumor exists post-surgical therapy;andConditions:Ampullary adenocarcinoma;orAppendiceal adenocarcinoma;orBiliary tract cancer (gallbladder, cholangiocarcinoma);orColorectal cancer;orMalignant pleural mesothelioma;orMedullary thyroid carcinoma;orMetastatic breast cancer;orMultiple Endocrine Neo [...]
As part of initial evaluation for suspected or diagnosed disease;or
To determine whether residual tumor exists post-surgical therapy;and
Conditions:Ampullary adenocarcinoma;orAppendiceal adenocarcinoma;orBiliary tract cancer (gallbladder, cholangiocarcinoma);orColorectal cancer;orMalignant pleural mesothelioma;orMedullary thyroid carcinoma;orMetastatic breast cancer;orMultiple Endocrine Neoplasia Type 2 (MEN2);orOvarian, primary peritoneal, or fallopian tube cancer;orPancreatic neoplasms;orRectal cancer;orSmall bowel adenocarcinoma (duodenum, jejunum, ileum).
Ampullary adenocarcinoma;or
Appendiceal adenocarcinoma;or

ANTHEM-CG-LAB-33 — CG-LAB-33 Carcinoembryonic Antigen Testing

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