Does Z17.0 require prior authorization?

No, Z17.0 does not require prior authorization (high confidence). Covered without prior authorization.

`Z17.0`, Estrogen receptor positive status [ER+]

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Enter '1' in the Days/Unit field on the claim when billing for MammaPrint®.
For CPT non-NOC codes, submit required information using SV101-7 or SV202-7 (preferred) or the NTE field.
Enter the appropriate DEX Z-Code™ identifier adjacent to the CPT code in the comment/narrative field for Part B claims (Loop 2400 or SV101-7 for 837P; Box 19 for paper claims).
Enter the appropriate DEX Z-Code™ identifier adjacent to the CPT code in the comment/narrative field for Part A claims (Line SV202-7 for 837I electronic claim; Block 80 for UB04).

MammaPrint® is indicated to analyze gene expression of FFPE breast cancer tissue to assess a patient's risk for distant metastasis (early-stage breast cancer).
The test may be performed using either the FDA-cleared microarray assay or a next-generation sequencing (NGS)-based assay.
PIK3CA targeted gene sequencing is indicated to detect PIK3CA mutations in patients with hormone receptor (HR)-positive, HER2-negative, advanced or metastatic breast cancer (postmenopausal women and men) who have progressed on or after an endocrine-based regimen when results will inform treatment with alpelisib (Piqray).
Oncotype DX Breast is intended for patients with estrogen-receptor (ER) positive micrometastases of carcinoma of the breast.
Oncotype DX Breast is intended for patients with estrogen-receptor (ER) positive breast carcinoma with 1–3 positive lymph nodes.
Oncotype DX Breast is intended for patients with estrogen-receptor (ER) positive, node-negative invasive carcinoma of the breast.

CGS-J15-L37832, MolDX: Breast Cancer IndexÂ® (BCI) Gene Expression Test

J15

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

J15

CGS-J18-L36021, MolDX: Molecular Diagnostic Tests (MDT)

J18

CGS-J18-L37832, MolDX: Breast Cancer IndexÂ® (BCI) Gene Expression Test

J18

Ask Backwork about documentation requirements, denial risks, or coverage in your state.