Does C50.321 require prior authorization?

No, C50.321 does not require prior authorization (high confidence). Code is covered without prior authorization.

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`C50.321`, Malignant neoplasm of lower-inner quadrant of right male breast

ICD-10-CM

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Documentation Required

Screening mammography does not require a physician referral and is not subject to the Medicare Part B deductible or coinsurance.
Diagnostic mammography requires a treating provider's referral specifying the diagnosis prompting the request, except when a screening mammogram is converted to diagnostic on the same day (a note in the radiologist's report fulfills the referral requirement).
Breast ultrasound requires an order from the treating provider (physician or qualified non-physician practitioner), except this order requirement does not apply to hospital-based radiologists for inpatient or outpatient breast ultrasound.
Breast MRI requires an order from a treating provider (physician or qualified non-physician practitioner).
Ductography requires a referring provider's (physician or qualified non-physician practitioner) referral and must be performed under the personal supervision of a physician qualified in ductography.
Diagnostic mammography must be performed under the direct supervision of an interpreting physician qualified in mammography; for digital diagnostic mammography, direct supervision may be accomplished via telemammography with the interpreting physician immediately available.

Key Coverage Criteria

Breast MRI is indicated for patients with positive axillary nodes and no known primary breast lesion to locate an occult primary.
Medicare covers annual screening mammography for all women age >=40 and one baseline screening mammography for women age 35-39, using bilateral views.
Breast MRI is indicated for suspected implant rupture when MRI is planned or otherwise appropriate.
Diagnostic mammography is indicated for patients with signs or symptoms suggestive of breast malignancy (e.g., palpable mass, spontaneous nipple discharge, skin changes, unilateral breast pain, unilateral axillary lymphadenopathy).
Diagnostic mammography is indicated for radiographic abnormalities detected on screening mammography.
Diagnostic mammography is indicated when metastatic disease of undetermined etiology is present and the breast is suspected as the primary source, or for axillary lymphadenopathy of undetermined etiology.

20 Active Policies

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

J15

CGS-J15-L40386, Erythropoiesis Stimulating Agents (ESA)

J15

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

J15

CGS-J15-L34356, Erythropoiesis Stimulating Agents (ESA)

J15

CGS-J15-L34037, Flow Cytometry

J15

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

J15

CGS-J15-L33950, Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography

J15

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

J15

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

J15

CGS-J15-L39017, MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer

J15

CGS-J15-L39506, Cosmetic and Reconstructive Surgery

J15

CGS-J15-L36658, Proton Beam Therapy

J15

CGS-J15-L40225, MolDX: Non-Next Generation Sequencing Targeted Molecular Panel Tests for Predictive Testing in Cancer

J15

CGS-J18-L38065, MolDX: Plasma-Based Genomic Profiling in Solid Tumors

J18

CGS-J18-L34356, Erythropoiesis Stimulating Agents (ESA)

J18

CGS-J18-L34037, Flow Cytometry

J18

CGS-J18-L33950, Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography

J18

CGS-J18-L36021, MolDX: Molecular Diagnostic Tests (MDT)

J18

CGS-J18-L36658, Proton Beam Therapy

J18

CGS-J18-L38067, MolDX: Next-Generation Sequencing for Solid Tumors

J18

Have a follow-up question?

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

Ask Backwork about C50.321 Sign up free

C50.321, Malignant neoplasm of lower-inner quadrant of right male breast

ICD-10-CM

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Documentation Required

Screening mammography does not require a physician referral and is not subject to the Medicare Part B deductible or coinsurance.
Diagnostic mammography requires a treating provider's referral specifying the diagnosis prompting the request, except when a screening mammogram is converted to diagnostic on the same day (a note in the radiologist's report fulfills the referral requirement).
Breast ultrasound requires an order from the treating provider (physician or qualified non-physician practitioner), except this order requirement does not apply to hospital-based radiologists for inpatient or outpatient breast ultrasound.
Breast MRI requires an order from a treating provider (physician or qualified non-physician practitioner).
Ductography requires a referring provider's (physician or qualified non-physician practitioner) referral and must be performed under the personal supervision of a physician qualified in ductography.
Diagnostic mammography must be performed under the direct supervision of an interpreting physician qualified in mammography; for digital diagnostic mammography, direct supervision may be accomplished via telemammography with the interpreting physician immediately available.

Key Coverage Criteria

Breast MRI is indicated for patients with positive axillary nodes and no known primary breast lesion to locate an occult primary.
Medicare covers annual screening mammography for all women age >=40 and one baseline screening mammography for women age 35-39, using bilateral views.
Breast MRI is indicated for suspected implant rupture when MRI is planned or otherwise appropriate.
Diagnostic mammography is indicated for patients with signs or symptoms suggestive of breast malignancy (e.g., palpable mass, spontaneous nipple discharge, skin changes, unilateral breast pain, unilateral axillary lymphadenopathy).
Diagnostic mammography is indicated for radiographic abnormalities detected on screening mammography.
Diagnostic mammography is indicated when metastatic disease of undetermined etiology is present and the breast is suspected as the primary source, or for axillary lymphadenopathy of undetermined etiology.

20 Active Policies

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

J15

CGS-J15-L40386, Erythropoiesis Stimulating Agents (ESA)

J15

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

J15

CGS-J15-L34356, Erythropoiesis Stimulating Agents (ESA)

J15

CGS-J15-L34037, Flow Cytometry

J15

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

J15

CGS-J15-L33950, Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography

J15

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

J15

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

J15

CGS-J15-L39017, MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer

J15

CGS-J15-L39506, Cosmetic and Reconstructive Surgery

J15

CGS-J15-L36658, Proton Beam Therapy

J15

CGS-J15-L40225, MolDX: Non-Next Generation Sequencing Targeted Molecular Panel Tests for Predictive Testing in Cancer

J15

CGS-J18-L38065, MolDX: Plasma-Based Genomic Profiling in Solid Tumors

J18

CGS-J18-L34356, Erythropoiesis Stimulating Agents (ESA)

J18

CGS-J18-L34037, Flow Cytometry

J18

CGS-J18-L33950, Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography

J18

CGS-J18-L36021, MolDX: Molecular Diagnostic Tests (MDT)

J18

CGS-J18-L36658, Proton Beam Therapy

J18

CGS-J18-L38067, MolDX: Next-Generation Sequencing for Solid Tumors

J18

Have a follow-up question?

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

Ask Backwork about C50.321 Sign up free

`C50.321`, Malignant neoplasm of lower-inner quadrant of right male breast

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`C50.321`, Malignant neoplasm of lower-inner quadrant of right male breast

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

C50.321, Malignant neoplasm of lower-inner quadrant of right male breast

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

C50.321, Malignant neoplasm of lower-inner quadrant of right male breast

Prior Authorization

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`C50.321`, Malignant neoplasm of lower-inner quadrant of right male breast

`C50.321`, Malignant neoplasm of lower-inner quadrant of right male breast