Does C80.1 require prior authorization?

No, C80.1 does not require prior authorization (high confidence). Covered without prior authorization.

`C80.1`, Malignant (primary) neoplasm, unspecified

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Screening mammography does not require a physician referral and is not subject to the Medicare Part B deductible or coinsurance.
Diagnostic mammography requires a treating provider's referral specifying the diagnosis prompting the request, except when a screening mammogram is converted to diagnostic on the same day (a note in the radiologist's report fulfills the referral requirement).
Breast ultrasound requires an order from the treating provider (physician or qualified non-physician practitioner), except this order requirement does not apply to hospital-based radiologists for inpatient or outpatient breast ultrasound.
Breast MRI requires an order from a treating provider (physician or qualified non-physician practitioner).

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.
Diagnostic mammography is indicated when metastatic disease of undetermined etiology is present and the breast is suspected as the primary source, or for axillary lymphadenopathy of undetermined etiology.

CGS-J15-L38067, MolDX: Next-Generation Sequencing for Solid Tumors

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

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

J15

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

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