Does D3A.019 require prior authorization?

No, D3A.019 does not require prior authorization (high confidence). Covered without prior authorization.

`D3A.019`, Benign carcinoid tumor of the small intestine, unspecified portion

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

When required, enter the test identifier or short narrative (e.g., 'Initial Work-Up …', 'ThyraMIR', 'Oncomine DX', 'ColonSeq', 'LungSeq', 'MyPRS') in the claim comment/narrative field (Part B: Loop 2400 NTE02 or SV101-7 for 5010A1 837P; Part A: Loop SV202-7 for 837I or Block 80 for UB04; paper: Box 19 or attachment).
For Rosetta Cancer Origin and VeriStrat claims submit a brief 'Initial Work-Up …' comment (under 80 characters) indicating preliminary pathology/imaging or predictive-testing evaluation has been performed.
For OVA1 claims enter 'The patient meets all 3 FDA OVA1 criteria' in the claim narrative (Loop 2400 NTE02, SV101-7, Loop SV202-7, Block 80, or Box 19 as applicable).

Oncomine DX Test (CPT 0022U) is covered when billed with CPT 0022U and the claim narrative contains the identifier 'Oncomine DX'.
Rosetta Cancer Origin Test (CPT 81479) is covered when conventional surgical pathology and/or imaging work-up is unable to identify a primary neoplastic site and an 'Initial Work-Up …' comment is submitted on the claim.
VeriStrat assay (CPT 81538) is covered when a preliminary predictive testing evaluation has been performed prior to ordering and an 'Initial Work-Up …' comment is submitted on the claim.
OVA1 proteomic assay (CPT 81503) is covered for women >18 years old who have an ovarian mass and have surgery planned; the claim must include the narrative 'The patient meets all 3 FDA OVA1 criteria'.
PROGENSA PCA3 (CPT 81313) is covered for appropriate prostate indications when the claim contains 'PCA3' and one of the ICD-10-CM codes listed in ICD-10-CM Codes that Support Medical Necessity Group 9.
MyPRS genetic expression profile testing (CPT 81479) is covered when 'MyPRS' is entered in box 19 (or electronic equivalent) and the claim includes one of the ICD-10-CM codes listed in ICD-10-CM Codes that Support Medical Necessity Group 24.

CGS-J15-L34081, Endoscopy by Capsule

J15

CGS-J18-L34081, Endoscopy by Capsule

J18

WPS-J5-L34614, Colonoscopy and Sigmoidoscopy-Diagnostic

A56394, Billing and Coding: Colonoscopy and Sigmoidoscopy-Diagnostic

A57452, Billing and Coding: Peripheral Nerve Blocks

NGS-J6-L36850, Peripheral Nerve Blocks

WPS-J8-L34614, Colonoscopy and Sigmoidoscopy-Diagnostic

FIRST_COAST-L33933, Peripheral Nerve Blocks

NOVITAS-JH-L35396, Biomarkers for Oncology

NGS-JK-L36850, Peripheral Nerve Blocks

A52986, Billing and Coding: Biomarkers for Oncology

NOVITAS-JL-L35396, Biomarkers for Oncology

A56461, Billing and Coding: Endoscopy by Capsule

A56580, Billing and Coding: Computerized Axial Tomography (CT), Thorax

A56612, Billing and Coding: CT of the Head

A56727, Billing and Coding: Wireless Capsule Endoscopy

A56421, Billing and Coding: CT of the Abdomen and Pelvis

A57788, Billing and Coding: Peripheral Nerve Blocks