Does C72.30 require prior authorization?

No, C72.30 does not require prior authorization (high confidence). Code is covered without prior authorization.

`C72.30`, Malignant neoplasm of unspecified optic nerve

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

The medical record must document that the testing is expected to influence treatment and include the ordering physician/NPP history and physical, exam findings, problems/diagnoses, and relevant data (e.g., lab tests, imaging).
The laboratory or billing provider must retain the physician requisition that sets forth the diagnosis/ICD-10-CM code that warrants the test(s).
Performing laboratory documentation (when requested) must include lab accreditation, test requisition, test records/procedures, preliminary and final reports, and quality control records.
For laboratory-developed tests (LDTs)/protocols (when requested) documentation must include assay description, lab/manufacturer, comparable assays/services (if relevant), and evidence of analytical validity, clinical validity, and clinical utility.

Coverage is allowed for targeted genomic sequence analysis panels for treatment of solid organ neoplasms when the panel is a DNA analysis panel containing at least 5 gene tests for molecular biomarkers that meet Medicare coverage criteria.
Coverage is allowed when the genomic testing is expected to influence the treatment of the condition (i.e., documentation supports that test results will affect clinical management of the solid organ neoplasm).
Genomic testing of acquired conditions such as malignancies, including separate malignancies developing at different times, is permitted when medically reasonable and necessary to assess response or other clinically relevant criteria.
Stereotactic radiosurgery (SRS) is typically furnished as a single session; when more than one session is required, bill using stereotactic body radiation therapy (SBRT) codes instead of SRS codes.
Coverage on an individual (redetermination/appeal) basis may be considered for lesions that require a high radiation dose per fraction to avoid exposure of surrounding tissues when documentation and supporting literature are provided.
Initial MRD testing is covered for patients with cancer when baseline tumor profiling from a prior analysis is utilized, using listed bespoke/plasma-series MRD tests (e.g., Signatera Bespoke Assay Design + Plasma Series Bundle, RaDaR Bespoke Assay Design + Plasma Series Bundle, Oncodetect Bespoke Assay Design + Plasma Test Bundle, Guardant Reveal MRD Bundle, Guardant360 Response).

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

J15

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

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.