Skip to main content

HCPCS/CPT PD-L1 | No Prior Auth

Ask Verity/PD-L1

`PD-L1`

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Documentation Required

Refer to the referenced MolDX LCDs (L38335, L38337, L38394, L38435) for required clinical documentation, test reports, and justification for medical necessity.
No explicit documentation requirements provided in the excerpt.
Clinical documentation confirming disease status where required by the clinical utility criteria (e.g., documentation that cholangiocarcinoma or gallbladder cancer is unresectable or metastatic).
Documentation that testing is consistent with evidence-based indications per NCCN guidelines when applicable.

Key Coverage Criteria

Microsatellite Instability/Mismatch Repair Testing
MSI/dMMR - Companion Diagnostic
NTRK Gene Testing
PDGFRA Gene Testing
PD-L1 IHC Testing
PIK3CA Gene Testing

1 Active Policy

HUMANA-SINGLE-GENE-AND-MOLECULAR-BIOMARKER-TESTING-FOR-SOLID-TUMORS-MA — Single Gene and Molecular Biomarker Testing for Solid Tumors - Medicare Advantage

Related Codes

FGFR1(1 policies)FGFR2(1 policies)FGFR3(1 policies)

Have a follow-up question?

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

Test order and resulting report (i.e., the actual molecular test result) and supporting clinical notes demonstrating medical necessity.

For KIT gene testing in the listed jurisdictions, documentation must satisfy the criteria contained in LCD - Molecular Pathology Procedures (L35000).