Does C78.00 require prior authorization?

No, C78.00 does not require prior authorization (high confidence). Code is covered without prior authorization.

`C78.00` — Secondary malignant neoplasm of unspecified lung

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medical records for patients receiving a once‑yearly implant must document ongoing follow‑up visits at least every 3 to 4 months and must be provided upon request; lack of requested documentation will result in denial as not medically necessary.
Physician documentation supporting reasonable expectation of survival >12 months is required for coverage of once‑yearly implants for prostate cancer.
Billing frequency should match the drug formulation administered (e.g., bill Vantas 50 mg implant once per 12 months, Eligard 22.5 mg billed per its 3‑month formulation); medical record must support billed frequency when requested.
A written, signed, and dated order for the oral anticancer drug must be received by the supplier before submitting the claim.

GnRH/LHRH analogs (leuprolide, goserelin, triptorelin, histrelin, leuprolide mesylate/Camcevi) are covered for FDA‑approved indications and for recognized off‑label uses that meet the criteria of LCD L33394.
Leuprolide acetate and histrelin implants administered every 12 months are covered for treatment of prostate cancer when the treating physician reasonably expects the patient to survive at least 12 months.
GnRH analogs are covered when administered at frequencies consistent with the specific product's labeled duration of action (e.g., monthly, every 3, 4, 6, or 12 months).
An oral anticancer drug is covered only if it is an FDA-approved drug or biological and meets all other Medicare statutory/regulatory requirements.
The oral drug must have the same active ingredient and the same chemical/generic name as a non-self-administrable anticancer drug or be a prodrug metabolized to the same active ingredient as the covered non-self-administerable form.
The oral anticancer drug must be used for the same anticancer chemotherapeutic indications (including off-label uses) as the non-self-administerable form.

A55147 — Billing and Coding: MolDX: bioTheranostics Cancer TYPE ID Update

J05

A57581 — Billing and Coding: MolDX: NRAS Genetic Testing

J05

L36807 — MolDX: Molecular Diagnostic Tests (MDT)

J05

L36797 — MolDX: NRAS Genetic Testing

J05

A52453

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