Does C79.52 require prior authorization?

No, C79.52 does not require prior authorization (high confidence). Covered without prior authorization.

`C79.52`, Secondary malignant neoplasm of bone marrow

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.
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.
Diagnostic mammography is indicated for patients with signs or symptoms suggestive of breast malignancy (e.g., palpable mass, spontaneous nipple discharge, skin changes, unilateral breast pain, unilateral axillary lymphadenopathy).
Diagnostic mammography is indicated for radiographic abnormalities detected on screening mammography.

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

J15

CGS-J15-L35442, MolDX: NRAS Genetic Testing

J15

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

J15

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

J15

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