Does C79.00 require prior authorization?

No, C79.00 does not require prior authorization (high confidence). Code is covered without prior authorization.

`C79.00` — Secondary malignant neoplasm of unspecified kidney and renal pelvis

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

This billing/coding guideline complements LCD L33459 (Computerized Axial Tomography (CT), Thorax); follow the LCD for clinical coverage and any required documentation or prior authorization rules.
When billing J7999-KD, enter the name and total dose (mg or mcg) of each drug in Box 19 of the CMS-1500 or the appropriate electronic comment loop; if Box 19 cannot accommodate all information, attach the details to the paper claim.
If a portion of a single-dose vial is not used, submit the HCPCS code for the drug on a separate claim line and append modifier JW to indicate discarded/unused portion.
Separate payment may be made for pump refilling and/or adjustments; submit these services using the appropriate drug refill or maintenance CPT/HCPCS code that accurately describes the service rendered.

Compounded medications for use in implantable infusion pumps may be covered by Medicare when their use meets all other criteria for services provided incident to a physician's service.
True off-the-shelf (non‑compounded) drugs used without compounding and administered via DME may be billed using the drug-specific HCPCS code and are reimbursed under CMS ASP methodology.
If Prialt® is implanted as a single agent in the pump, bill using HCPCS code J2278-KD.
Compounded single-agent or combination drug formulations used in implanted infusion pumps must be billed using HCPCS code J7999-KD for reimbursement.
Coverage is allowed for targeted genomic sequence analysis panels for treatment of solid organ neoplasms when the panel is a DNA analysis panel containing at least 5 gene tests for molecular biomarkers that meet Medicare coverage criteria.
Coverage is allowed when the genomic testing is expected to influence the treatment of the condition (i.e., documentation supports that test results will affect clinical management of the solid organ neoplasm).

A57581 — Billing and Coding: MolDX: NRAS Genetic Testing

J05

L36797 — MolDX: NRAS Genetic Testing

J05

L37810 — Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms

J06

A56867 — Billing and Coding: Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms

J06

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