Does C79.19 require prior authorization?

No, C79.19 does not require prior authorization (high confidence). Covered without prior authorization.

`C79.19`, Secondary malignant neoplasm of other urinary organs

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Submit the appropriate CPT code for the KRAS test and enter 1 unit of service (UOS) on the claim.
Include the assigned DEX Z-Code™ identifier in the comment/narrative field for Part B electronic claims (Loop 2400 or SV101-7 for 5010A1 837P) or on an attachment for paper Part B claims.
For Part A claims, enter the assigned DEX Z-Code™ identifier adjacent to the CPT code in the comment/narrative field (Line SV202-7 for 837I electronic claims or Block 80 for the UB04 form).
Labs may use SV101-7, SV202-7 (preferred), or the NTE field to submit the required information when reporting the KRAS test on electronic claims.

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®).
Biocept Target Selector HER2 Assay and Androgen Receptor Variant (AR-V7) Protein Test for phenotypic biomarker detection from circulating tumor cells is considered reasonable and necessary per MolDX LCD L38678.
Flow cytometry is covered to detect antigens used as therapeutic targets in neoplastic disease.
Flow cytometry is covered for diagnosis and classification of hematopoietic neoplasms.
Flow cytometry is covered to assess biologic parameters associated with prognosis in hematopoietic neoplasms.

CGS-J15-L36021, MolDX: Molecular Diagnostic Tests (MDT)

J15

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

J15

CGS-J15-L34037, Flow Cytometry

J15

CGS-J15-L35442, MolDX: NRAS Genetic Testing

J15

CGS-J15-L40386

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