Does C82.00 require prior authorization?

No, C82.00 does not require prior authorization (high confidence). Code is covered without prior authorization.

Verity

`C82.00` — Follicular lymphoma grade I, unspecified site

ICD-10-CM

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Documentation Required

Use CPT code 81540 on the claim when billing for Cancer TYPE ID.
Enter '1' in the Days/Unit field on the claim for this test.
Submit the required test identifier information using SV101-7 or SV202-7 (SV202-7 preferred) or via the NTE field if needed.
Include the appropriate DEX Z-Code identifier adjacent to the CPT code in the claim comment/narrative field for Part B claims (Loop 2400 or SV101-7 for 5010A1 837P; Box 19 for paper claims).

Key Coverage Criteria

Bill Cancer TYPE ID using CPT code 81540 (mRNA gene expression assay of 92 genes) for evaluation of tumors of unknown origin.
When a molecular panel of 5–50 genes is ordered, bill the appropriate panel CPT code (81445, 81449, 81450, or 81451) instead of submitting individual single-gene CPT codes.
When 51 or more genes are ordered for molecular biomarkers, bill the appropriate large-panel CPT code (81455 or 81456) rather than individual gene codes.
When a panel contains more than one but fewer than five genes, use the corresponding existing panel CPT code or CPT 81479 (unlisted molecular pathology procedure) if no specific panel CPT exists.
Use modifier 91 only when a test is performed more than once on the same day for the same patient and the repeat testing is necessary to obtain multiple results in the course of treatment.
25-hydroxy vitamin D testing (including fractions, if performed) is covered when deemed reasonable and necessary per Local Coverage Determination L33771.

20 Active Policies

L38835 — MolDX: Minimal Residual Disease Testing for Cancer

J05

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

J05

L39477 — Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin's and Non-Hodgkin's Lymphoma with B-cell or T-cell Origin

J05

L34658 — Vitamin D Assay Testing

J05

Have a follow-up question?

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

Include the appropriate DEX Z-Code identifier adjacent to the CPT code in the claim comment/narrative field for Part A claims (Line SV202-7 for 837I electronic claims; Block 80 for UB04 paper claims).

Select and report an appropriate ICD-10-CM diagnosis code on the claim that supports the medical necessity for the test.

L36807 — MolDX: Molecular Diagnostic Tests (MDT)

A59259 — Billing and Coding: Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin's and Non-Hodgkin's Lymphoma with B-cell or T-cell Origin

J05

A57484 — Billing and Coding: Vitamin D Assay Testing

J05

A59004 — Billing and Coding: MolDX: Minimal Residual Disease Testing for Hematologic Cancers

J05

L39297 — Off-label Use of Rituximab and Rituximab Biosimilars

J06

A60186 — Billing and Coding: Off-label Use of Rituximab and Rituximab Biosimilars

J06

A59101 — Billing and Coding: Off-label Use of Rituximab and Rituximab Biosimilars

J06

A59311 — Billing and Coding: Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin and Non-Hodgkin Lymphoma with B-cell or T-cell Origin

J06

A59926 — Billing and Coding: Molecular Pathology Procedures

J06

L35000 — Molecular Pathology Procedures

J06

A56199 — Billing and Coding: Molecular Pathology Procedures

J06

L39513 — Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin and Non-Hodgkin Lymphoma with B-cell or T-cell Origin

J06

A57452 — Billing and Coding: Peripheral Nerve Blocks

J06

L36850 — Peripheral Nerve Blocks

J06

L40180 — Off-label Use of Rituximab and Rituximab Biosimilars

J06

A56841 — Billing and Coding: Vitamin D; 25 hydroxy, includes fraction(s), if performed

J09

C82.00 — Follicular lymphoma grade I, unspecified site