UnitedHealthcare Oxford Genetic and Molecular Lab Testing Notification/Prior Authorization Requirement

Effective April 1, 2020, UnitedHealthcare will expand the existing prior authorization/notification for genetic and molecular testing performed in an outpatient setting to Oxford members. BRCA prior authorization requirements will not change with this expansion.

Care providers will use the Genetic and Molecular Test tool on Link to submit the notification/ prior authorization request. You’ll fill in the member’s information and choose the test and the lab to perform the test. Ordering providers will need to submit requests for tests that require authorization. Labs may submit their own notification requests for tests that only require notification.

The following will require notification/prior authorization:

• Tier 1 Molecular Pathology Procedures

• Tier 2 Molecular Pathology Procedures

• Genomic Sequencing Procedures

• Multianalyte Assays with Algorithmic Analyses that include Molecular Pathology Testing

CPT codes included: 0001U, 0081U, 0004M, 81545, 0012U – 0014U, 0084U, 0006M – 0007M, 81552, 0016U – 0019U, 0087U – 0091U, 0011M – 0013M ,81595 – 81599, 0022U – 0023U, 0094U, 81105 – 81111, 87480 – 87482, 0026U – 0034U, 0097U – 0100U, 81120 – 81121, 87505 – 87507, 0036U – 0037U, 0101U – 0103U, 81161 – 81210 ,87510 – 87512, 0040U, 0111U, 81212, 87623, 0045U – 0050U, 0113U, 81215 – 81420, 87652, 0055U – 0057U, 0115U, 81425 – 81479, 87660 – 87661, 0060U, 0118U, 81507, 87797 – 87801, 0068U – 0076U, 0129U – 0138U, 81518 – 81522, S3870, 0078U, 0152U – 0162U, 81542