Molecular Pathology Codes No Longer Requiring a Service Authorization

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: • The member must display clinical features, or • Is at direct risk of inheriting the mutation in question (pre-symptomatic); and • The result of the test will have a direct impact on the treatment being delivered to the member.

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INDUSTRY NEWS TAGS: Medicaid Virginia

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