Does Z19.2 require prior authorization?

No, Z19.2 does not require prior authorization (high confidence). Code is covered without prior authorization.

`Z19.2`, Hormone resistant malignancy status

ICD-10-CM

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Select and report the appropriate ICD-10-CM diagnosis code when submitting the claim.
Report the service using CPT code 81479.
Enter 1 unit of service (UOS) when reporting the test.
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).

Biocept Target Selector HER2 Assay is considered reasonable and necessary per this billing guidance in accordance with LCD L38566.
Androgen Receptor Variant (AR-V7) Protein Test is considered reasonable and necessary per this billing guidance in accordance with LCD L38566.
Biocept Target Selector HER2 Assay is considered reasonable and necessary when clinical criteria of MolDX LCD L38584 are met; report using CPT 81479 with the appropriate DEX Z-Code.
Androgen Receptor Variant (AR-V7) Protein Test is considered reasonable and necessary when clinical criteria of MolDX LCD L38584 are met; report using CPT 81479 with the appropriate DEX Z-Code.
Biocept Target Selector HER2 Assay is identified as reasonable and necessary for coverage per the related LCD L38643.
Androgen Receptor Variant (AR-V7) Protein Test is identified as reasonable and necessary for coverage per the related LCD L38643.

CGS-J15-L38584, MolDX: Phenotypic Biomarker Detection from Circulating Tumor Cells

J15

CGS-J18-L38584, MolDX: Phenotypic Biomarker Detection from Circulating Tumor Cells

J18

A58205, Billing and Coding: MolDX: Phenotypic Biomarker Detection from Circulating Tumor Cells

WPS-J5-L38678, MolDX: Phenotypic Biomarker Detection from Circulating Tumor Cells

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