Does C71.9 require prior authorization?

No, C71.9 does not require prior authorization (high confidence). Code is covered without prior authorization.

`C71.9`, Malignant neoplasm of brain, unspecified

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.
ESA therapy is covered to treat clinically significant anemia by elevating or maintaining red blood cell levels (as demonstrated by Hgb/Hct) to decrease anemia and reduce the need for transfusions.
End stage renal disease (ESRD) patients on dialysis with anemia (Hgb < 10.0 g/dL or Hct < 30%) are eligible for ESA therapy.
Chronic kidney disease (not on dialysis) patients with anemia (Hgb < 10.0 g/dL or Hct < 30%) and evidence of marked renal dysfunction (serum creatinine >= 3 mg/dL OR creatinine clearance < 60 mL/min OR GFR < 60 mL/min/1.73 m2) are eligible for ESA therapy.
Patients with non-myeloid malignancies who have anemia due to concomitant myelosuppressive chemotherapy are eligible for ESA therapy when the hemoglobin immediately prior to initiation or maintenance is < 10.0 g/dL (Hct < 30%).
Patients with anemia due to AZT and/or other nucleoside reverse transcriptase inhibitors (NRTIs) for HIV/AIDS with Hgb < 10.0 g/dL or Hct < 30% at initiation are eligible for ESA therapy.

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

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

J15

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