Genetic Testing for Colorectal Cancer Procedure Code 81288 Requires Prior Authorization

Genetic testing for colorectal cancer procedure code 81288 requires prior authorization. Prior authorization requests may be submitted to the TMHP Prior Authorization Department via mail, fax, or the electronic portal. Prescribing or ordering providers, dispensing providers, clients’ responsible adults, and clients may sign prior authorization forms and supporting documentation using electronic or wet signatures. A completed Special Medical Prior Authorization (SMPA) request form, signed and dated by the referring provider, must be submitted. Any provider’s signature, including the prescribing provider’s, on a submitted document indicates that the provider certifies, to the best of the provider’s knowledge, the information in the document is true, accurate, and complete. Medical documentation submitted by the physician with the SMPA request form must verify the client’s diagnosis or family history. Requisition forms from laboratories are not sufficient for verification of personal or family history.