Does C21.1 require prior authorization?

No, C21.1 does not require prior authorization (high confidence). Code is covered without prior authorization.

`C21.1` — Malignant neoplasm of anal canal

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.
When a molecular panel of 5–50 genes is ordered, bill the appropriate panel CPT code (81445, 81449, 81450, or 81451) instead of submitting individual single-gene CPT codes.
When 51 or more genes are ordered for molecular biomarkers, bill the appropriate large-panel CPT code (81455 or 81456) rather than individual gene codes.
When a panel contains more than one but fewer than five genes, use the corresponding existing panel CPT code or CPT 81479 (unlisted molecular pathology procedure) if no specific panel CPT exists.

L39040 — MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer

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

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L36807 — MolDX: Molecular Diagnostic Tests (MDT)

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A56394 — Billing and Coding: Colonoscopy and Sigmoidoscopy-Diagnostic

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