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    • September 28, 2017

    Provider letters have been sent explaining that Cystic Fibrosis screening will not be covered in the general population, However, this code may be considered medically necessary as a diagnostic test following abnormal newborn screening or in children with clinical features suggestive of cystic fibrosis.

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    • September 28, 2017

    The Genetic Testing Guidelines have been updated.  As of September 1, 2017 certain Molecular Pathology codes will require a prior authorization.

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    • August 29, 2017

    As part of its 2017 permanent rule changes, OHCA amended OAC §§ 317:30-3-4.1(1)(E) and 317:30-3-30(b) to clarify when medical records must be signed and dated, for the purposes of Medicaid reimbursement. The changes were made through the usual permanent rulemaking process, and the agency did not receive any negative comments about the proposed... more

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    • March 27, 2017

    Molecular pathology services, including genetic testing, are rapidly becoming the standard of care in diagnostic medicine and other related areas. OHCA is committed to ongoing evaluation of the clinical evidence supporting the use of these services to ensure that medically necessary tests and technologies are available to our members. MDOK has... more

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    • March 27, 2017

    The proposed amendment to the State Plan will allow members to access genetic counseling after genetic testing has found that a member displays clinical features of a suspected genetic condition, is at direct risk of inheriting the genetic condition in question, or has been diagnosed with a condition where identification of specific genetic... more

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    • September 24, 2013

    This message is regarding genetic tests used to determine carrier status for cystic fibrosis (CF), Fragile X, and spinal muscular atrophy (SMA). Consistent with the recommendations set forth by ACMG and ACOG, OHCA considers CF carrier screening using the common mutation panel (CPT code 81220) to be medically necessary once in a lifetime for... more

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    • April 22, 2013

    This message is regarding services for cell-free fetal DNA testing billed to members served by the Oklahoma Health Care Authority (OHCA). These tests may be marketed under trade names including MaterniT21 (Sequenom),Harmony (LabCorp/Ariosa), Panorama (Bio-Reference Labs/Quest/Natera), or Verifi (Verinata).  The list prices for these tests... more

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    • February 28, 2013

    This message clarifies billing requirements for claims involving molecular pathology CPT codes in the 81200-81479 range.  Because these codes are manually priced, providers will need to submit an attachment (itemized invoice of services performed) with any claims that include molecular pathology procedures. Claims involving molecular... more

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