Genetic Testing Codes Open with Prior Authorization by Physician Review

A mandatory secondary review is required by a physician for all requests for array-based cytogenetic testing for detection of chromosomal abnormalities. To help determine medical necessity specific documentation should be included.

• 81228 Cytogenomic constitutional microarray analysis; interrogation of genomic regions for copy number variants or oligo-based comparative genomic hybridization
• 81229 Cytogenomic constitutional microarray analysis; interrogation of genomic regions for copy number and single nucleotide polymorphism variants for chromosomal abnormalities

Source: https://medicaid.utah.gov/Documents/manuals/pdfs/Medicaid Information Bulletins/Traditional Medicaid Program/2015/January2015-MIB.pdf