United Healthcare Requires Pre-Authorization for Genetic and Molecular Testing

Effective November 1, 2017, United Healthcare implemented a new process that requires preauthorization for the following tests:

  • 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
    • 00001U
    • 0004M-0008M
    • 81161-81421
    • 81423-81479
    • 81507
    • 81519
    • 81545-81599

Ordering care providers will initiate prior authorization through BeaconLBS.  You will need an Optum ID to access the Genetic and Molecular Test app in Link.  For more information you can contact BeaconLBS at 1-800-377-8809 or visit their Frequently Asked Questions page here.

Failure to obtain a preauthorization or signed ABN for the tests below may result in charges being billed back to your facility.

 

Test #

Test Name

CPT Code

8338

BCR-ABL1, Minor (p190), Quantitative

81207

8339

BCR-ABL1, Qualitative with Reflex to BCR-ABL1 Quantitative

81206, 81207

8340

BCR-ABL1, Major (p210), Quantitative

81206

8551

BCR/ABL1 Qualitative Diagnostic Assay w/ Reflex

81206, 81207, 81208

8569

BCR/ABL1 Qualitative Diagnostic Assay

81206, 81207, 81208

8570

BCR/ABL1, p210, mRNA Detection, RT-PCR, Quantitative, Monitoring CML

81206

8362

Breast and Ovarian Hereditary Cancer Syndrome Sequencing

81211

7649

Cystic Fibrosis (CFTR) 165 Pathogenic Variants

81220

2070

Factor 5 Leiden (LF5) w/Prothrombin Factor II G20210A

81240, 81241

2071

Factor 5 Leiden

81241

2072

Prothrombin G20210A Nucleotide Gene Mutation

81240

9744

Hemochromatosis, Hereditary (HFE 3 Mutations)

81256

9311

JAK-2 (V617F) Mutation, Qualitative

81270

8140

MTHFR (Methylenetrahydrofolate Reductase) Mutation Detection PCR

81291

8554

PML/RARA Quant by PCR

81315

2400

T-cell Receptor Gamma Chain Rearrangement by DNA Amplification

81342

8556

UGT1A1 TA Repeat Genotype

81350

8397

Celiac Disease (HLA-DQ2 and HLA-DQ8) Genotyping

81383, 81376 x2

5235

Apolipoprotein E (APOE) Genotyping, Cardiovascular Risk

81401

8311

T-Cell Receptor Excision Circles (TREC) Analysis

81479

 


 

TEST COLLECTION/TRANSPORT CHANGE FOR FECAL OCCULT BLOOD TESTING

Please discard Hemoccult collection cards and use new Hemosure collection tubes

Effective December 1, 2017 Fecal Occult Blood testing will be performed at Physicians Laboratory utilizing the Hemosure® One Step Immunological Fecal Occult Blood Test (iFOB).  Hemosure® iFOB is a rapid, immunochemical test for the qualitative determination of Fecal Occult Blood from the lower GI tract.

Hemosure® iFOB detects lower levels of fecal occult blood than the standard guaiac tests by employing an immunospecific, sandwich assay that is not affected by dietary peroxidases, animal blood, or ascorbic acid.  Only one sample needs to be submitted for screening or diagnostic testing.

 

Test #    Test Name
2620       Occult blood (Diagnostic)                            CPT 82274
620         Occult blood (Screening)                             CPT 82274 (Medicare CPT G0328)

 

Acceptable Specimen Types:
Fecal sample in Hemosure® iFOB sample collection tube (preferred)*
-or-  Fecal sample in clean container received at PLS Omaha location within 24 hours of collection

 

*Specimen Stability in Hemosure® collection tube: 
Room temperature 6 days.
Sample in collection tube may also be refrigerated up to 30 days.

NOTE:  Standard guaiac based (Hemoccult) cards will continue to be accepted for a limited time to allow for dispersed patient supplies to be returned to client offices.