UHC Genetic and Molecular Lab Testing Prior Authorization Requirement

October 2017 ~

Next month, UnitedHealthcare (UHC) will require a new online notification/prior authorization process for genetic and molecular lab tests for their Commercial benefit plan members. According to the insurer, these tests may offer treatment options for some patients and the updated requirements will support the use of appropriate proven testing, while keeping patient safety a priority.

Effective November 1, 2017, the following tests will require ordering care providers to request notification/prior authorization through this process before the lab tests can be reimbursed:

  • 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:
    • 0001U
    • 0004M
    • 0008M
    • 81161
    • 81421
    • 81423
    • 81479
    • 81507
    • 81519
    • 81545
    • 81599
    • 0009M (prior authorization required starting January 1, 2018)
    • S3870 (prior authorization required starting January 1, 2018)

To complete the online notification/prior authorization process for tests included in the Genetic and Molecular Lab Test requirement, UHC directs ordering care provider to sign in to Link by going to UHCprovider.com.

Care providers will be able to choose the test and the lab to perform the test, but only if the lab registers their tests for the process. The insurer notes that if request meets UHC’s clinical and coverage guidelines, providers will get a decision at the time the request is submitted online. If it is determined more information or clinical documentation is needed, UHC will contact the provider.

CPT® is a registered trademark of the American Medical Association (AMA). All rights reserved.



Source(s): UnitedHealthcare Network Bulletin;