Documentation Requirements
- Updated list of CPT codes with associated documentation requirements; added 0265U, 0335U, 0336U, 0425U, and 0426U
- Updated list of required clinical information:
- Added:
- Any relevant metabolic disease laboratory results
- For prenatal testing, in addition to the above, also include:
- Source of the sample
- Fetal ultrasound findings
- Removed:
- Ethnicity/ancestry (e.g., Ashkenazi Jewish), if reason for testing
- Genetic counseling (if available)
- Replaced “any prior genetic testing results” with “all prior genetic testing results”
Definitions
- Removed definition of “Medically Necessary”
Applicable Codes
- Added CPT codes 0260U, 0264U, 0266U, and 0267U
- Removed CPT code 0036U
Source: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/whole-exome-and-whole-genome-sequencing.pdf
