Molecular Pathology Codes No Longer Requiring a Service Authorization
INDUSTRY NEWS TAGS: Medicaid Virginia
The purpose of this memorandum is to notify providers of changes to service authorization requirements for molecular pathology codes in the CPT range 81200-81599 and S3854. Effective with dates of service on or after May 01, 2014, codes in this range will no longer require a service authorization.
DMAS considers genetic testing medically necessary to establish a molecular diagnosis of an inheritable disease when all of the following are met:
â€¢ The member must display clinical features, or
â€¢ Is at direct risk of inheriting the mutation in question (pre-symptomatic); and
â€¢ The result of the test will have a direct impact on the treatment being delivered to the member.