UnitedHealthcare Commercial Reimbursement Policy Updates- Molecular Pathology Policy, Professional

Effective Date: New Nov. 1, 2019

• The new Molecular Pathology Policy will be effective beginning with dates of service on and after Nov. 1, 2019.
• As previously communicated, the AMA Claim Designation code or Abbreviated Gene Name should be reported in loop 2400 or SV101-7 field for electronic claims or Box 24 for paper claims. For identification, the ZZ qualifier is required in front of the claim designation code or Abbreviated Gene Name (e.g., ZZCLRN1).
• When submitting code 81479, unlisted molecular pathology, the Genetic Test Registry (GTR) unique ID should be reported in loop 2400 or SV101-7 field for electronic claims or in Box 24 for paper claims (e.g., GTR123456789).
• Claims that have complied with notification or prior authorization requirements in UnitedHealthcare’s Genetic Testing and Molecular Prior Authorization Program satisfy the policy’s requirements without further care provider action as long as they meet UnitedHealthcare’s Genetic Test Lab Registry requirements.

Source: https://www.uhcprovider.com/content/dam/provider/docs/public/resources/news/2019/network-bulletin/October-2019-Network-Bulletin.pdf