[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-288917-105":53,"doc-detail-288917-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","combined-pa-list-prior-authorization-codes","Combined PA List - Prior Authorization Codes","","Combined PA List provides a structured mapping between combined prior authorization (PA) lists and specific medical test billing/procedure codes, including detailed code descriptions, effective start and termination dates, and additional medical policy references. Entries distinguish coverage applicability across Medicare and other lines of business (e.g., Commercial/ASO, OHP, PEBB). 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The row’s combined PA list and the medical policy name indicate the applicable scope.",{"name":115,"@type":106,"acceptedAnswer":116},"What do the effective and termination dates represent?",{"text":117,"@type":109},"The Prior Authorization Effective Date and Prior Authorization Termination Date specify the coverage window for the prior authorization entry associated with each code.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},288917,1789973554,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":50,"category_name":51,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":79,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":135,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":141},1099514068365,"https://ap-avatar.wpscdn.com/avatar/10000253d8d9f28188e?_k=1776742907772140068","| Combined PA List | Code | Code Description | Prior Authorization Effective Date | Prior Authorization Termination Date | Combined Additional Notes | Medical Policy Name: Policy |\n| --- | --- | --- | --- | --- | --- | --- |\n| Medicare | 0002U | Oncology (colorectal), quantitative assessment of three urine metabolites (ascorbic acid, succinic acid and carnitine) by liquid chromatography with tandem mass spectrometry (LC-MS/MS) using multiple reaction monitoring acquisition, algorithm reported as likelihood of adenomatous polyps | 07/01/2017 | 09/30/2017 |  | Investigational and Non Covered Medical Technology Medicare Only |\n| Commercial/ASO, Medicare, OHP, PEBB | 0002U | Oncology (colorectal), quantitative assessment of three urine metabolites (ascorbic acid, succinic acid and carnitine) by liquid chromatography with tandem mass spectrometry (LC-MS/MS) using multiple reaction monitoring acquisition, algorithm reported as likelihood of adenomatous polyps | 07/01/2017 | 09/30/2017 |  | General Requirements-Genetic Testing (Cytogenetic Studies) and Counseling |\n| Medicare | 0004U | Infectious disease (bacterial), DNA, 27\u003Cbr>resistance genes, PCR amplification and probe hybridization in microarray format (molecular detection and identification of AmpC, carbapenemase and ESBL coding genes), bacterial culture colonies, report of genes detected or not detected, per isolate | 07/01/2017 | 12/31/2017 |  | Investigational and Non Covered Medical Technology Medicare Only |\n| Medicare | 0005U | Oncology (prostate) gene expression profile by real-time RT-PCR of 3 genes (ERG, PCA3, and SPDEF), urine, algorithm reported as risk score | 07/01/2017 | 03/31/2018 |  | Prostate: Protein Biomarkers and Genetic Testing (Medicare Only) |\n| Commercial/ASO, Medicare, OHP, PEBB | 0008M | Oncology (breast), mRNA analysis of 58 genes using hybrid capture, on formalin-fixed paraffin-embedded (FFPE) tissue, prognostic algorithm reported as a risk score | 09/01/2017 | 12/31/2017 |  | Genetic Testing: Gene Expression Profile Testing for Breast Cancer (All Lines of Business except Medicare) |\n| Medicare | 0009M | Fetal aneuploidy (trisomy 21, and 18) DNA sequence analysis of selected regions using maternal plasma, algorithm reported as a risk score for each trisomy | 07/01/2018 |  |  | Genetic Testing: Reproductive Planning and Prenatal Testing (Medicare Only) |\n| Commercial/ASO, OHP, PEBB | 0009M | Fetal aneuploidy (trisomy 21, and 18) DNA sequence analysis of selected regions using maternal plasma, algorithm reported as a risk score for each trisomy | 07/01/2015 |  |  | Genetic Testing: Reproductive Planning and Prenatal Testing (All Lines of Business Except Medicare) |\n\n| Combined PA List | Code | Code Description | Prior Authorization Effective Date | Prior Authorization Termination Date | Combined Additional Notes | Medical Policy Name: Policy |\n| --- | --- | --- | --- | --- | --- | --- |\n| Commercial/ASO, Medicare, OHP, PEBB | 0009U | Oncology (breast cancer), ERBB2 (HER2) copy number by FISH, tumor cells from formalinfixed paraffin-embedded tissue isolated using image-based dielectrophoresis (DEP) sorting, reported as ERBB2 gene amplified or nonamplified | 08/01/2018 |  |  | Non-Small Cell Lung Cancer: Molecular Testing for Targeted Therapy (All Lines of Business Except Medicare); Non-Small Cell Lung Cancer:\u003Cbr>Molecular Testing for Targeted Therapy (Medicare Only) |\n| Commercial/ASO, Medicare, OHP, PEBB | 0017U | Oncology (hematolymphoid neoplasia), JAK2 mutation, DNA, PCR amplification of exons 12- 14 and sequence analysis, blood or bone marrow, report of JAK2 mutation not detected or detected | 03/01/2018 |  |  | Genetic Testing: JAK2, CALR, and MPL (All Lines of Business except Medicare); Genetic Testing: JAK2, CALR, and MPL (Medicare Only) |\n| Medicare | 0018U | Oncology (thyroid), microRNA profiling by RTPCR of 10 microRNA sequences, utilizing fine needle aspirate, algorithm reported as a positive or negative result for moderate to high risk of m","cbCaisF71o0K1Ryq","https://ap.wps.com/l/cbCaisF71o0K1Ryq","pdf",8914487,302,"English","# Combined PA List\n## Code and Code Description\n## Prior Authorization Dates\n## Combined Additional Notes and Medical Policy Name","[{\"question\":\"What information does the Combined PA List include for each entry?\",\"answer\":\"Each row lists the combined PA list, a code, a detailed code description, prior authorization effective and termination dates, combined additional notes, and the associated medical policy name.\"},{\"question\":\"How are Medicare and other lines of business handled in the list?\",\"answer\":\"Some codes are marked as Medicare only, while others apply to Commercial/ASO, Medicare, OHP, and PEBB. The row’s combined PA list and the medical policy name indicate the applicable scope.\"},{\"question\":\"What do the effective and termination dates represent?\",\"answer\":\"The Prior Authorization Effective Date and Prior Authorization Termination Date specify the coverage window for the prior authorization entry associated with each code.\"}]","Combined PA List - Prior Authorization Codes | PDF",1789634212,106]