Does C50.011 require prior authorization?

No, C50.011 does not require prior authorization (high confidence). Code is covered without prior authorization.

`C50.011` — Malignant neoplasm of nipple and areola, right female breast

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Enter '1' in the Days/Unit field on the claim when billing for MammaPrint®.
For CPT non-NOC codes, submit required information using SV101-7 or SV202-7 (preferred) or the NTE field.
Enter the appropriate DEX Z-Code™ identifier adjacent to the CPT code in the comment/narrative field for Part B claims (Loop 2400 or SV101-7 for 837P; Box 19 for paper claims).
Enter the appropriate DEX Z-Code™ identifier adjacent to the CPT code in the comment/narrative field for Part A claims (Line SV202-7 for 837I electronic claim; Block 80 for UB04).

MammaPrint® is indicated to analyze gene expression of FFPE breast cancer tissue to assess a patient's risk for distant metastasis (early-stage breast cancer).
The test may be performed using either the FDA-cleared microarray assay or a next-generation sequencing (NGS)-based assay.
PIK3CA targeted gene sequencing is indicated to detect PIK3CA mutations in patients with hormone receptor (HR)-positive, HER2-negative, advanced or metastatic breast cancer (postmenopausal women and men) who have progressed on or after an endocrine-based regimen when results will inform treatment with alpelisib (Piqray).
Germline testing is covered when the patient has ovarian, breast, pancreatic, or prostate cancer and meets clinical indication for immediate treatment with an FDA‑approved PARP inhibitor.
Testing for deleterious variants in homologous recombination repair (HRR) genes (e.g., BRCA1, BRCA2) is covered as an aid when results will be used to determine eligibility for PARP inhibitor therapy.
Limited germline testing of a select group of genes (rather than a comprehensive panel) is covered when the patient does not meet criteria for larger panel testing per LCD L39040 and limited testing is necessary to comply with FDA indicated drug usage.

L38678 — MolDX: Phenotypic Biomarker Detection from Circulating Tumor Cells

J05

L38835 — MolDX: Minimal Residual Disease Testing for Cancer

J05

A58756 — Billing and Coding: MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer

J05

A60309 — Billing and Coding: MolDX: Non-Next Generation Sequencing Targeted Molecular Panel Tests for Predictive Testing in Cancer

J05

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