Does C20 require prior authorization?

No, C20 does not require prior authorization (high confidence). Code is covered without prior authorization.

`C20` — Malignant neoplasm of rectum

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Report BRAF V600 test kit services using CPT code 81210 on claims.
Submit the assigned DEX Z-Code™ Identifier in the comment/narrative field: Loop 2400 or SV101-7 for 5010A1 837P electronic claims; alternatively use SV202-7 (preferred) or the NTE field.
For paper Part B claims attach the DEX Z-Code identifier to the claim; for Part A enter the DEX Z-Code adjacent to CPT on Line SV202-7 for 837I electronic claims or Block 80 on the UB-04 form.
Select and report the appropriate ICD-10-CM diagnosis code for melanoma on the claim.

BRAF V600 mutation testing (cobas® 4800 BRAF V600) is covered to detect BRAF mutation in melanoma to determine eligibility for vemurafenib (Zelboraf) in patients with melanoma that is unresectable or metastatic.
BRAF V600E and V600K mutation testing (ThxID™ BRAF V600/K) is covered to identify melanoma patients whose tumors carry V600E and/or V600K mutations for selection of dabrafenib (Tafinlar) and/or trametinib (Mekinist).
Oncotype DX Colon Cancer Assay is intended to predict recurrence risk for patients with Stage II colon cancer.
Diagnostic colonoscopy or sigmoidoscopy is covered to directly visualize the lower gastrointestinal tract (colon, rectum, sigmoid) to detect polyps, tumors, or other intestinal lesions.
Diagnostic colonoscopy is covered when identification of the site of pathology and/or obtaining a biopsy during the procedure is clinically indicated.
A follow-on screening colonoscopy is covered after a positive covered blood-based biomarker noninvasive colorectal cancer (CRC) screening test per NCD 210.3, effective 2025-01-01.

L36797 — MolDX: NRAS Genetic Testing

J05

A55161 — Billing and Coding: MolDX: FDA-Approved BRAF Tests

J05

L38168 — MolDX: Plasma-Based Genomic Profiling in Solid Tumors

J05

L36807 — MolDX: Molecular Diagnostic Tests (MDT)

J05

L40277 — MolDX: Non-Next Generation Sequencing Targeted Molecular Panel Tests for Predictive Testing in Cancer

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