Does 87506 require prior authorization?

No, 87506 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 87506?

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

Enter 1 unit of service (UOS) for the Molecular Diagnostic Test on the claim.
Report the appropriate CPT code for the Molecular Diagnostic Test on the claim.
For Part B electronic (837P) claims, enter the appropriate DEX Z-Code identifier adjacent to the CPT code in Loop 2400 or the SV101-7 comment/narrative field.
For Part B paper claims, enter the appropriate DEX Z-Code identifier adjacent to the CPT code in Box 19.

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).
FDA-approved/cleared molecular infectious disease pathogen identification tests performed consistent with their intended use and billed with an appropriate accompanying ICD-10-CM diagnosis code are covered without a DEX Z-code.
Expanded (>5 pathogens) respiratory (RP), pneumonia (PNP), and gastrointestinal (GI) panels are covered when billed from Place of Service (POS) 19, 21, 22, or 23.
Expanded (>5 pathogens) RP/PNP panels for immune-competent beneficiaries are covered when ordered by an Infectious Disease specialist, or by a Pulmonologist (for RP/PNP) or Gastroenterologist (for GI) who is diagnosing and treating the beneficiary, with appropriate documentation and ICD-10 codes as required.
Expanded (>5 pathogens) RP/PNP/GI panels for immune-compromised beneficiaries are covered when ordered by a clinician specialist in Infectious Diseases, Oncology, Transplant, Pulmonology (RP/PNP), or Gastroenterology (GI) who is diagnosing and treating the beneficiary, with required documentation and ICD-10 codes.
Pre-transplant evaluation molecular panels for immune-compromised beneficiaries are covered regardless of symptoms when clear documentation of the pre-transplant evaluation accompanies the claim.

A58761 — Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

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

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L39044 — MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing

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L36807 — MolDX: Molecular Diagnostic Tests (MDT)

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