Prior Authorization

Prior authorization for advanced diagnostic testing is becoming increasingly common. Several benefit providers now require physicians who order certain advanced diagnostics to obtain prior authorization before testing is performed.

As the provider of several laboratory tests which require prior authorization, CSI Laboratories will require clients to include prior authorization information on the requisition when ordering tests. Requisitions received without proper prior authorization information may cause a delay in the billing process.

Should you have questions about the submission of prior authorization information, please contact your local Territory Sales Specialist.

May 1, 2017 – Avalon Healthcare Solutions – North Carolina and South Carolina Blue Cross Blue Shield

Please use the attached pre-authorization form when submitting test requisitions to CSI Laboratories:

Pre-authorization Request Form for BCBS Avalon patients

For South Carolina patients, find out if the tests you are ordering require a pre-authorization by Avalon: Lab Test Requiring Pre-Authorizations by Avalon

November 1, 2017 – UnitedHealthcare Prior Authorizations:

Starting Nov. 1, 2017, notification is required for certain genetic and molecular lab tests for some 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