Prior Authorization Required for BRCA Testing

Prior Authorization is required for initial testing of Breast Cancer Gene 1 and 2 (BRCA) for Texas Medicaid (procedure codes 81211, 81212, 81214, 81215, 81216, and 81217). Providers may refer to the current Texas Medicaid Provider Procedures Manual, Radiology and Laboratory Services Handbook for complete prior authorization criteria. Prior Authorization is not required for BRCA large arrangement gene mutation analysis testing (procedure code 812813) when submitted with a negative test result for procedure code 81211. Prior Authorization for additional BRCA testing may be considered on a case-by-case basis by Medical Director review when testing criteria for these studies are met.