Molecular Pathology Codes No Longer Requiring a Service Authorization

The purpose of this memorandum is to notify providers of changes to service authorization requirements for molecular pathology codes in the CPT range 81200-81599 and S3854. Effective with dates of service on or after May 01, 2014, codes in this range will no longer require a service authorization. DMAS considers genetic testing medically necessary to establish a molecular diagnosis of an inheritable disease when all of the following are met: • The member must display clinical features, or • Is at direct risk of inheriting the mutation in question (pre-symptomatic); and • The result of the test will have a direct impact on the treatment being delivered to the member.

Source: https://www.virginiamedicaid.dmas.virginia.gov/wps/portal/!ut/p/c5/04_SB8K8xLLM9MSSzPy8xBz9CP0os3hnX59AH_MgIwODAH9XA89g72DjME9XAwNnQ6B8JFDe3dHDxNzHwMDC09nEwNPEyT_IyNXfwMDTmIDucJB9-PWD5A1wAEcDqH64DSEuQP3B_r6e_uYGxgYWZvp-Hvm5qfoFuREGmQHpigBu4LqA/dl3/d3/L0lDU0lKSmdrS0NsRUpDZ3BSQ1NBL29Ob2dBRUlRaGpFS0lRQUJHY1p3aklDa3FTaFNOQkFOYUEhIS80QzFiOVdfTnIwZ0RFU1pJSlJERVNaTUpRaUlrZmchIS83XzJBVjY4SjM1MTA3NTUwSUk4VTFOVUEyMDA0LzZVN0pZNjI4OTAwMDcvaWJtLmludi8yNjUwNDYyMTA5NTUvamF2YXguc2VydmxldC5pbmNsdWRlLnBhdGhfaW5mby8lMFZBTWVtb1BvcnRsZXRWaWV3LmpzcA!!/