Does C78.01 require prior authorization?

No, C78.01 does not require prior authorization (high confidence). Code is covered without prior authorization.

`C78.01` — Secondary malignant neoplasm of right 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.
When required, enter the test identifier or short narrative (e.g., 'Initial Work-Up …', 'ThyraMIR', 'Oncomine DX', 'ColonSeq', 'LungSeq', 'MyPRS') in the claim comment/narrative field (Part B: Loop 2400 NTE02 or SV101-7 for 5010A1 837P; Part A: Loop SV202-7 for 837I or Block 80 for UB04; paper: Box 19 or attachment).

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).
Oncomine DX Test (CPT 0022U) is covered when billed with CPT 0022U and the claim narrative contains the identifier 'Oncomine DX'.
Rosetta Cancer Origin Test (CPT 81479) is covered when conventional surgical pathology and/or imaging work-up is unable to identify a primary neoplastic site and an 'Initial Work-Up …' comment is submitted on the claim.
VeriStrat assay (CPT 81538) is covered when a preliminary predictive testing evaluation has been performed prior to ordering and an 'Initial Work-Up …' comment is submitted on the claim.

A57581 — Billing and Coding: MolDX: NRAS Genetic Testing

J05

L36807 — MolDX: Molecular Diagnostic Tests (MDT)

J05

L38678 — MolDX: Phenotypic Biomarker Detection from Circulating Tumor Cells

J05

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

J05

A58205

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