Does C34.30 require prior authorization?

No, C34.30 does not require prior authorization (high confidence). Code is covered without prior authorization.

`C34.30`, Malignant neoplasm of lower lobe, unspecified bronchus or lung

ICD-10-CM

No Prior Auth Required

Code is 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.
Laboratories must follow the test indications as published by the test developer when performing and billing molecular diagnostic tests covered under MolDX.
MolDX will cover a molecular diagnostic test only if the test has completed MolDX registration and a technical assessment (TA) and demonstrates analytical validity, clinical validity, and clinical utility meeting Medicare's reasonable and necessary standard.
Tests that have completed registration/TA and have an assigned unique test identifier are eligible for reimbursement for dates of service consistent with the effective date of the MolDX coverage determination.
This policy applies to all non‑FDA approved laboratory developed tests (LDTs), modified FDA‑approved/cleared kits/tests/assays, tests billed with more than one code (method/serology/anatomic pathology combinations), and tests meeting those descriptions billed with an NOC code; such tests must follow the MolDX registration/TA process to be covered.
MolDX (Palmetto GBA) coverage determinations are accepted by CGS Administrators and constitute the basis for coverage decisions under this policy.

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

J15

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

J15

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

J15

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

J15

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