Does C34.00 require prior authorization?

No, C34.00 does not require prior authorization (high confidence). Covered without prior authorization.

`C34.00`, Malignant neoplasm of unspecified main bronchus

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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).

Bill Cancer TYPE ID using CPT code 81540 (mRNA gene expression assay of 92 genes) for evaluation of tumors of unknown origin.
The cobas EGFR Mutation Test v2 is indicated as a companion diagnostic to detect defined EGFR mutations in patients with non-small cell lung cancer (NSCLC) using DNA from formalin-fixed paraffin-embedded tumor tissue (FFPET) or circulating tumor DNA (cfDNA) from plasma to aid selection of targeted therapies per FDA-approved labeling.
Patients with positive cobas EGFR Mutation Test v2 results for EGFR exon 19 deletions or L858R in plasma are eligible for treatment with erlotinib (TARCEVA) according to the test's FDA-approved indication.
Detection of EGFR T790M by an FDA-approved EGFR kit (e.g., cobas) in NSCLC patients is indicated to identify patients eligible for osimertinib (TAGRISSO) per FDA-approved labeling.
The therascreen EGFR RGQ PCR kit is indicated for detection of EGFR mutations in NSCLC tumor tissue (FFPET) to help select patients for afatinib (GILOTRIF) according to FDA-approved labeling.
Laboratories must follow the test indications as published by the test developer when performing and billing molecular diagnostic tests covered under MolDX.

CGS-J15-L36021, MolDX: Molecular Diagnostic Tests (MDT)

J15

CGS-J15-L38822, MolDX: Minimal Residual Disease Testing for Cancer

J15

CGS-J15-L38065, MolDX: Plasma-Based Genomic Profiling in Solid Tumors

J15

CGS-J15-L38067, MolDX: Next-Generation Sequencing for Solid Tumors

J15

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