Does C78.1 require prior authorization?

No, C78.1 does not require prior authorization (high confidence). Covered without prior authorization.

`C78.1`, Secondary malignant neoplasm of mediastinum

ICD-10-CM

No Prior Auth Required

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.
therascreen® KRAS test: detection of somatic KRAS mutations to identify colorectal cancer (CRC) patients for treatment with cetuximab (Erbitux®).
cobas® KRAS test: detection of KRAS mutations in codons 12 and 13 to identify colorectal cancer (CRC) patients for treatment with cetuximab (Erbitux®) or panitumumab (Vectibix®).
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.

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

J15

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

J15

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

J15

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

J15

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