Does C79.00 require prior authorization?

No, C79.00 does not require prior authorization (high confidence). Covered without prior authorization.

`C79.00`, Secondary malignant neoplasm of unspecified kidney and renal pelvis

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Claims must report the appropriate CPT code for the flow cytometry service, include 1 unit of service (UOS), and list the appropriate ICD-10-CM diagnosis code.
Medical necessity documentation per LCD L34513 is required when coverage criteria are not fully met in this billing guideline (for example, when >24 markers are requested).
Medical records must document that sipuleucel-T is being used according to NCD 110.22 and consistent with the FDA label, including documentation of diagnosis, symptom status (asymptomatic or minimally symptomatic), and that the autologous cellular process (leukapheresis, activation, reinfusion) was followed.
Use HCPCS Q2043 for dates of service on or after 2011-07-01; for dates prior to 2011-07-01 bill J3490, J3590, or C9273 (C9273 being replaced by Q2043).

Coverage and medical necessity determinations for flow cytometry are governed by Local Coverage Determination L34513.
Flow cytometry may be used to analyze cellular components of body fluids and lymphoreticular tissues, including peripheral blood, cerebrospinal fluid (CSF), bone marrow, lymph nodes, tonsil, spleen, and fine needle aspirate material.
Peripheral blood or fine needle aspirate specimens may be used to avoid more invasive diagnostic procedures when clinically appropriate.
Sipuleucel-T is covered for patients with asymptomatic or minimally symptomatic metastatic castrate-resistant (hormone-refractory) prostate cancer when used according to NCD 110.22 and consistent with the FDA label.
Coverage applies only for the FDA-approved autologous cellular immunotherapy procedure involving leukapheresis, antigen activation, and reinfusion administered as described in the product labeling.
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.

CGS-J15-L35442, MolDX: NRAS Genetic Testing

J15

CGS-J18-L35442, MolDX: NRAS Genetic Testing

J18

WPS-J5-L36797, MolDX: NRAS Genetic Testing

A57581, Billing and Coding: MolDX: NRAS Genetic Testing

NGS-J6-L35076

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