Does C50.029 require prior authorization?

No, C50.029 does not require prior authorization (high confidence). Covered without prior authorization.

`C50.029`, Malignant neoplasm of nipple and areola, unspecified male breast

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Each claim must include the assigned MolDX unique test identifier as additional claim documentation to allow adjudication and crosswalk to the test details on file.
Laboratories must submit a comprehensive dossier/technical assessment for each new test/assay to MolDX prior to claim submission.
Providers should use MolDX/Palmetto GBA resources for specific coding, billing information, and coverage determinations (see PalmettoGBA.com/MolDX).
The assigned unique identifier will serve as a crosswalk to the detailed test information on file, minimizing the need to submit the full TA information with each claim.

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.
Patient has a recurrent, relapsed, refractory, metastatic, or advanced solid tumor that did not originate from the central nervous system.

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

J15

CGS-J15-L38584, MolDX: Phenotypic Biomarker Detection from Circulating Tumor Cells

J15

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

J15

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

J15

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