TX – Prior Authorization Required for BRCA Testing, Colorectal Cancer Procedure

March 2017 ~

Texas Medicaid requires prior authorization for initial testing of Breast Cancer Gene 1 and 2 (BRCA) for Texas Medicaid (procedure codes 81211, 81212, 81214, 81215, 81216, and 81217).

The prior authorization request must include documentation that indicates that the client meets one or more of the criteria outlined in the Provider Handbook. Prior authorization for additional BRCA testing may be considered on a case-by-case basis by Medical Director review.

For complete prior authorization criteria refer to the current Texas Medicaid Provider Procedures Manual, Radiology and Laboratory Services Handbook.


Source(s): Texas Medicaid, February 2017; Texas Medicaid, February 2017;