Does D03.4 require prior authorization?

No, D03.4 does not require prior authorization (high confidence). Code is covered without prior authorization.

`D03.4`, Melanoma in situ of scalp and neck

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Report BRAF V600 test kit services using CPT code 81210 on claims.
Submit the assigned DEX Z-Code™ Identifier in the comment/narrative field: Loop 2400 or SV101-7 for 5010A1 837P electronic claims; alternatively use SV202-7 (preferred) or the NTE field.
For paper Part B claims attach the DEX Z-Code identifier to the claim; for Part A enter the DEX Z-Code adjacent to CPT on Line SV202-7 for 837I electronic claims or Block 80 on the UB-04 form.
Select and report the appropriate ICD-10-CM diagnosis code for melanoma on the claim.

BRAF V600 mutation testing (cobas® 4800 BRAF V600) is covered to detect BRAF mutation in melanoma to determine eligibility for vemurafenib (Zelboraf) in patients with melanoma that is unresectable or metastatic.
BRAF V600E and V600K mutation testing (ThxID™ BRAF V600/K) is covered to identify melanoma patients whose tumors carry V600E and/or V600K mutations for selection of dabrafenib (Tafinlar) and/or trametinib (Mekinist).
Mohs micrographic surgery is covered when selected because the lesion's complexity (e.g., poorly defined borders, suspected deep invasion, recurrent lesion, prior radiation), size, or anatomic location requires maximal tissue conservation and other approaches (standard excision or destruction) are not medically reasonable or necessary.
Mohs surgery is considered covered when the surgeon performs both the surgical excision and the pathologic examination (surgeon acting in integrated surgical and pathology roles) as part of the Mohs technique.
Lab-developed tests for inherited cancer syndromes in patients with cancer as described in Local Coverage Determination (LCD) L39040 are the services addressed by this billing/coding guidance.
Flow cytometry is covered to detect antigens used as therapeutic targets in neoplastic disease.

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

J15

CGS-J15-L34195, Mohs Micrographic Surgery

J15

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

J15

CGS-J15-L34037, Flow Cytometry

J15

CGS-J15-L34356

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