November 1, 2017 – UnitedHealthcare Prior Authorizations:

Starting Nov. 1, 2017, notification is required for certain genetic and molecular lab tests for certain UnitedHealthcare Commercial benefit plans. Ordering care providers will complete the notification/prior authorization process online or over the phone. Labs must register their tests to participate as part of the Genetic and Molecular Lab Testing Notification/Prior Authorization process.

Additional information on UnitedHealthcare’s prior authorization process can be found here: https://www.uhcprovider.com/en/prior-auth-advance-notification/genetic-molecular-lab.html

Frequently asked questions about this change to genetic and molecular lab testing can be found here: https://www.uhcprovider.com/content/dam/provider/docs/public/prior-auth/genetic-paan-faq.pdf

The following genetic and molecular tests listed below now require a pre-authorization:

  • 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
    • 0004M – 0008M
    • 0009M (required starting on Jan. 1, 2018)
    • S3870 (required starting on Jan. 1, 2018)
    • 81161 – 81421
    • 81423 – 81479
    • 81507
    • 81519
    • 81545 – 81599

The following plans do not require the genetic and molecular lab testing notification/prior authorization:

  • Neighborhood Health Partnership
  • Sierra
  • UnitedHealthcare of the Mid-Atlantic
  • UnitedHealthcare Oxford
  • UnitedHealthcare of the River Valley
  • UnitedHealthcare West
  • UnitedHealthOne