Ohio UHC Genetic and Molecular Lab Testing Notification/Prior Authorization Requirement

December 2019 ~

Effective March 1, 2020, UnitedHealthcare will require prior authorization/notification for genetic and molecular testing performed in an outpatient setting for UnitedHealthcare Community Plan members in Ohio.

According to the insurer, providers should use the Genetic and Molecular Lab Test tool on Link to submit the notification/prior authorization request, where they will be prompted to fill in the member’s information and then choose the test and lab to perform the test. Ordering care providers will need to submit requests for tests that require authorization. Labs may submit their own notification requests for tests that only require notification.

Beginning March 1, 2020, an approved notification/prior authorization will be required for tests such as:

• Tier 1 Molecular Pathology Procedures
• Tier 2 Molecular Pathology Procedures
• Genomic Sequencing Procedures
• Multianalyte Assays with Algorithmic Analyses that include Molecular Pathology Testing
• These CPT^® codes:
  • 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

CPT^® is a registered trademark of the American Medical Association.

Source(s): UnitedHealthcare Network Bulletin December 2019;