Does C78.30 require prior authorization?

No, C78.30 does not require prior authorization (high confidence). Covered without prior authorization.

`C78.30`, Secondary malignant neoplasm of unspecified respiratory organ

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

This article provides billing and coding guidelines that complement Local Coverage Determination (LCD) L37176 for White Cell Colony Stimulating Factors; refer to LCD L37176 for specific coverage criteria, indications, and limitations.
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.

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.
NRAS genetic testing services (MolDX L35442) should be reported when performed using the appropriate CPT code for the NRAS test.
CPT codes 64400-64530 for peripheral nerve blocks may be reported on the date of surgery when performed for postoperative pain management only if the operative anesthesia is general anesthesia, subarachnoid injection, or epidural injection and the adequacy of intraoperative anesthesia is not dependent on the peripheral nerve block.
Peripheral nerve block services that are separate, medically necessary services which cannot be rendered by the surgeon may be reported if the surgeon documents the reason for referral and the additional services are justified in the medical record.

CGS-J15-L35442, MolDX: NRAS Genetic Testing

J15

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

J15

CGS-J18-L38584, MolDX: Phenotypic Biomarker Detection from Circulating Tumor Cells

J18

CGS-J18-L35442, MolDX: NRAS Genetic Testing

J18

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