Reminder: Genetic Counseling Requirement Effective Jan. 1, 2016
December 30, 2015Effective Jan. 1, 2016, UnitedHealthcare commercial members with benefit plans that include medical necessity provisions will be required to receive genetic counseling before UnitedHealthcare approves prior authorization requests for testing for Breast Cancer (BRCA) mutations for hereditary breast and ovarian cancer. A genetic counseling visit will help UnitedHealthcare members understand the advantages and limitations of BRCA mutation analysis so they can make informed health care decisions. Genetic counseling, which is recommended by the United States Preventive Services Tasks Force as well as the National Comprehensive Cancer Network (NCCN), will help members understand if the test is right for them as well as help them interpret the results after testing. CPT codes impacted by this requirement include the following: 81211-81217, 81162, 81432 and 81433.