UnitedHealthcare Genetic and Molecular Testing Prior Authorization/Notification Requirement

Effective Oct. 1, 2017, UnitedHealthcare will start a national online prior authorization/notification program for genetic and molecular testing performed in an outpatient setting for our fully insured UnitedHealthcare Commercial members. Providers requesting laboratory testing will be required to complete the prior authorization/notification process. The process will require providers to indicate the laboratory and test name. The outpatient laboratory services will require prior authorization/ notification for specific Molecular Pathology codes: • 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 in the prior authorization:  0001U, 0004M – 0008M, 81161 – 81421, 81423 – 81479, 81507, 81519, and 81545 – 81599. Clinical information may be requested to determine if the request meets UnitedHealthcare’s clinical policy requirements for coverage; requests that meet UnitedHealthcare clinical criteria will be granted an authorization at the time of the request. United Healthcare will only authorize payment for those CPT codes that have been registered with the Genetic and Molecular Testing Prior Authorization/Notification Program for each specified genetic test. Details on how to obtain a prior authorization/notification will be included in upcoming issues of the Network Bulletin. Training options and additional information about this program will be available on around Sept. 1, 2017.

INDUSTRY NEWS TAGS: UnitedHealthcare

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