Does Z80.8 require prior authorization?

No, Z80.8 does not require prior authorization (high confidence). Covered without prior authorization.

`Z80.8`, Family history of malignant neoplasm of other organs or systems

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

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).
The policy text does not specify explicit required documentation fields or paperwork (no dedicated 'Documentation Requirements' section).
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.

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.

CIGNA-0549, Head and Neck Ultrasound

AETNA-CPB-0319, RET Proto-Oncogene Testing

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