Does 86301 require prior authorization?

No, 86301 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 86301?

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

CA 19-9 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 cancers (gallbladder, cholangiocarcinoma);orOvarian, primary peritoneal or fallopian tube cancer;orPancreatic adenocarcinoma;orSmall bowel adenocarcinoma (duodenum, jejunu [...]
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 cancers (gallbladder, cholangiocarcinoma);orOvarian, primary peritoneal or fallopian tube cancer;orPancreatic adenocarcinoma;orSmall bowel adenocarcinoma (duodenum, jejunum, ileum).
Ampullary adenocarcinoma;or
Appendiceal adenocarcinoma;or

ANTHEM-CG-LAB-35 — CG-LAB-35 Cancer Antigen 19-9 Testing

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