Does C34.91 require prior authorization?

No, C34.91 does not require prior authorization (high confidence). Code is covered without prior authorization.

`C34.91` — Malignant neoplasm of unspecified part of right bronchus or lung

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

When reporting the JW modifier for discarded drug, the medical record must clearly show the amount administered and the amount wasted.
Medical record must document prior anthracycline therapy for patients receiving albumin-bound paclitaxel, or clearly document a clinical contraindication to anthracycline therapy.
For claims with no discarded amounts from single-dose containers or single-use packages, include the JZ modifier as evidence on the claim (effective July 1, 2023).
Document dose and frequency as consistent with the FDA label or recognized compendia for the indication (including citations to the compendia if used for off-label indications).

Paclitaxel administered intravenously is covered for antineoplastic (cancer) indications when used in accordance with the FDA-approved labeling.
Off-label uses of paclitaxel are covered when supported by recognized compendia (e.g., NCCN, AHFS, Clinical Pharmacology, Lexi-Drugs, Micromedex) and dosing/frequency follow those compendia.
Albumin-bound paclitaxel (Abraxane) is covered when prior therapy included an anthracycline unless anthracycline therapy is clinically contraindicated.
Bill Cancer TYPE ID using CPT code 81540 (mRNA gene expression assay of 92 genes) for evaluation of tumors of unknown origin.
The cobas EGFR Mutation Test v2 is indicated as a companion diagnostic to detect defined EGFR mutations in patients with non-small cell lung cancer (NSCLC) using DNA from formalin-fixed paraffin-embedded tumor tissue (FFPET) or circulating tumor DNA (cfDNA) from plasma to aid selection of targeted therapies per FDA-approved labeling.
Patients with positive cobas EGFR Mutation Test v2 results for EGFR exon 19 deletions or L858R in plasma are eligible for treatment with erlotinib (TARCEVA) according to the test's FDA-approved indication.

A57112 — Billing and Coding: MolDX: Predictive Classifiers for Early Stage Non-Small Cell Lung Cancer

J05

L38443 — MolDX: Predictive Classifiers for Early Stage Non-Small Cell Lung Cancer

J05

L38158 — MolDX: Next-Generation Sequencing for Solid Tumors

J05

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

J05

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