G9840, Ras (kras and nras) gene mutation testing performed before initiation of
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Claims may require submission of clinical documentation to support the request.
- Clinical documentation may be required to support requests for somatic tumor testing.
Key Coverage Criteria
- MSI testing by PCR or dMMR testing by IHC is medically necessary for urothelial carcinoma of the bladder or upper urinary tract when the patient has biopsy-proven disease and has not had prior MSI or dMMR testing.
- FGFR variant testing in urothelial cancers is medically necessary when biopsy-proven urothelial malignancy is present, the disease is locally advanced, recurrent, or metastatic, the patient is a candidate for an FDA-approved FGFR-targeted therapy, and prior FGFR testing has not been performed.
- For malignant gliomas, targeted somatic tumor testing is medically necessary when biopsy-proven glioma and testing includes BRAF V600E, IDH1, and IDH2, and prior testing for these genes has not been performed.
- Cholangiocarcinoma panel testing for IDH1, FGFR, and BRAF pathogenic variants is medically necessary when biopsy-proven disease is locally advanced, unresectable, or metastatic; the patient is a candidate for FDA-approved targeted therapy based on panel results; and the patient has not had prior somatic tumor testing for IDH1, FGFR, and BRAF in the metastatic setting.
- Gene expression profiling to guide adjuvant therapy is medically necessary when surgery has been performed, pathology is complete, histology is ductal/lobular/mixed/metaplastic, ER+/PR+ or both with HER2-negative, node status is pN0 or pN1mi ≤2 mm, tumor features include specified size/grade criteria, and chemotherapy is being considered.
- Metastatic breast cancer tissue testing for PIK3CA/AKT1/PTEN/ESR1 variants is medically necessary when ER-positive and HER2-negative disease, candidate for FDA-labeled targeted therapy (e.g., alpelisib/capivasertib with fulvestrant or elacestrant), and no prior tissue-based testing for these genes in the metastatic setting.
2 Active Policies
CARELON-somatic-tumor-testing-2024-11-17-updated-2025-01-01, Somatic Tumor Testing
CARELON-somatic-tumor-testing-2025-11-15-updated-2026-04-01, Somatic Tumor Testing
Related Codes
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