Does Z17.0 require prior authorization?

No, Z17.0 does not require prior authorization (high confidence). Code is covered without prior authorization.

`Z17.0` — Estrogen receptor positive status [ER+]

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

For NGS performed on or after 2022-01-01, bill using CPT code 81523 adjacent to the appropriate DEX Z‑Code identifier in the claim narrative.
Enter '1' in the Days/Unit field on the claim for MammaPrint services.
For CPT non‑NOC codes, submit the required information using SV101-7 or SV202-7 (preferred) or the NTE field.
For Part B electronic claims, place the DEX Z‑Code adjacent to the CPT code in Loop 2400 or SV101-7 for 837P; for Part B paper claims place the DEX Z‑Code in Box 19.

MammaPrint is indicated to analyze the gene expression profile of FFPE breast cancer tissue to assess a patient's risk for distant metastasis.
MammaPrint is validated for use in early‑stage breast cancer (MINDACT) and may be used for patients with early‑stage breast cancer to inform risk of distant metastasis.
Oncotype DX Breast is indicated for estrogen-receptor (ER) positive, node-negative invasive carcinoma of the breast.
Oncotype DX Breast is indicated for estrogen-receptor (ER) positive micrometastases of carcinoma of the breast.
Oncotype DX Breast is indicated for estrogen-receptor (ER) positive breast carcinoma with 1–3 positive lymph nodes.
PIK3CA targeted gene sequencing is covered when performed to detect PIK3CA mutations in patients who are postmenopausal women or men with hormone receptor (HR)-positive, HER2-negative advanced or metastatic breast cancer following progression on or after an endocrine-based regimen.

A56335 — Billing and Coding: MolDX: Breast Cancer Index (BCI) Gene Expression Test

J05

A55230 — Billing and Coding: MolDX: Oncotype DX Breast Cancer Assay

J05

L36807 — MolDX: Molecular Diagnostic Tests (MDT)

J05

L37913 — MolDX: Breast Cancer Index (BCI) Gene Expression Test

J05

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