Does S3840 require prior authorization?

No, S3840 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for S3840?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`S3840`, Dna analysis for germline mutations of the ret proto-oncogene for

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Documentation of genetic counseling (recommendation/notes) prior to testing and evidence that testing is being used to guide clinical management (e.g., consideration of prophylactic thyroidectomy, surveillance plans for mutation-positive individuals).
Appropriate ICD-10 diagnosis codes on claims supporting medical necessity per the CPB (for covered indications: e.g., C73–C75.9, E07.0, Q43.1, Z80.8).

Implied/necessary documentation to support medical necessity (as extractable from the policy): documentation of family history (first- or second-degree relatives as applicable), diagnosis of MTC or apparently sporadic MTC, presence of Hirschsprung disease, presence of C-cell hyperplasia, presence of two or more endocrine tumors, or diagnosis of pheochromocytoma/paraganglioma/parathyroid carcinoma.

If testing is for a known familial RET mutation, documentation that a specific familial RET mutation exists (so testing can be targeted to that mutation) is implied by the policy statements ('Test for specific familial mutation').

Key Coverage Criteria

ICD-10 diagnosis listed as covered if selection criteria are met: E07.0 (Hypersecretion of calcitonin).
ICD-10 diagnosis listed as covered if selection criteria are met: Q43.1 (Hirschsprung's disease).
Tests for germline point mutations in the RET gene medically necessary for members who meet any of the following high-risk criteria:
Members who have first-degree blood relatives (ie, parent, full-sibling, child) with medullary thyroid carcinoma (MTC).
Members who have first- (i.e., parent, full-sibling, child) or second-degree (i.e., aunt, uncle, grandparent, grandchild, niece, nephew, half-sibling) blood relatives and germline RET mutations (Testing strategy: Test for specific familial mutation).
Members with any of the following: C-cell hyperplasia.

4 Active Policies

CARELON-hereditary-cancer-testing-2026-04-04-updated-2026-07-01, Hereditary Cancer Testing

AETNA-CPB-0319, RET Proto-Oncogene Testing

AMBETTER-CG-Hered-CA-Suscep-2025.1, Concert Genetic Testing: Hereditary Cancer Susceptibility

REGENCE-GT20, Genetic and Molecular Diagnostic Testing

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S3840, Dna analysis for germline mutations of the ret proto-oncogene for