Does C43.20 require prior authorization?

No, C43.20 does not require prior authorization (high confidence). Covered without prior authorization.

`C43.20`, Malignant melanoma of unspecified ear and external auricular canal

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Select and report the appropriate CPT code for the melanoma risk stratification molecular diagnostic service.
Enter the appropriate DEX Z-Code identifier adjacent to the CPT code in the comment/narrative field for Part B electronic claims (Loop 2400 or SV101-7 for 837P) and for Part B paper claims (Box 19).
Enter the appropriate DEX Z-Code identifier adjacent to the CPT code in the comment/narrative field for Part A claims: Line SV202-7 for 837I electronic claims and Block 80 for the UB-04 claim form.
Select and report the appropriate ICD-10-CM diagnosis code on the claim.

No clinical or radiographic evidence of metastatic disease (patient is non-metastatic).
Patient has a personal history of melanoma.
Patient has Stage T1b or higher disease.
Patient has Stage T1a disease with documented concern about adequacy of microstaging.
Patient is undergoing diagnostic workup or is being evaluated for treatment.
Presumed risk for a positive sentinel lymph node biopsy (SLNB), based on clinical, histological, or other information, is greater than 5%.

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

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-L39017, MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer

J15

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