Does Z86.001 require prior authorization?

No, Z86.001 does not require prior authorization (high confidence). Covered without prior authorization.

`Z86.001`, Personal history of in-situ neoplasm of cervix uteri

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

Select and report the appropriate CPT code for the laboratory-developed test.
Enter 1 unit of service (UOS) for the claim.
For Part B electronic professional claims (837P), place the appropriate DEX Z-Code identifier adjacent to the CPT code in Loop 2400 or SV101-7; for Part B paper claims, place it in Box 19.
For Part A electronic institutional claims (837I), place the appropriate DEX Z-Code identifier adjacent to the CPT code in Line SV202-7; for UB04 paper claims, place it in Block 80.

Lab-developed tests for inherited cancer syndromes in patients with cancer (per LCD L38966) are covered when billed with the required claim elements specified in this policy.
Coverage applies for lab-developed tests (LDTs) for inherited cancer syndromes in patients with cancer when billed in accordance with MolDX LCD L38972.
Lab-developed tests for inherited cancer syndromes in patients with cancer as described in Local Coverage Determination (LCD) L39040 are the services addressed by this billing/coding guidance.
Patient has any cancer diagnosis.
There is a clinical indication for germline (inherited) testing for hereditary cancer.
The patient has a risk factor for germline (inherited) cancer.

CGS-J15-L39017, MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer

J15

CGS-J18-L39017, MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer

J18

A58756, Billing and Coding: MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer

WPS-J5-L39040, MolDX: Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer

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