Changes to genetic and molecular testing coverage and prior authorization requirements
Starting Jan. 1, 2025, UnitedHealthcare will discontinue coverage and remove prior authorization requirements for multi-panel pharmacogenetic codes. This affects select UnitedHealthcare commercial plans and all UnitedHealthcare Exchange plans.
Affected plans
This affects the following UnitedHealthcare benefit plans:
- UnitedHealthcare of the Mid-Atlantic, Inc.
- UnitedHealthcare Plan of the River Valley, Inc.
- UnitedHealthcare Insurance Company of the River Valley
- Oxford Health Insurance, Inc.
- Harvard Pilgrim Health Care
- All Savers Insurance Company
- All Savers Life Insurance Company of California
- UnitedHealthcare Exchange plans
- Neighborhood Health Partnership, Inc.
What this means for you
UnitedHealthcare will no longer cover multi-panel genetic tests for behavioral health diagnoses. Providers will no longer be required to submit prior authorization requests for affected procedure codes.
The following procedure codes will be removed from existing prior authorization/advance notification requirements and claims for these codes will be denied as unproven and not medically necessary:
- 0029U
- 0173U
- 0175U
- 0345U
- 0411U
- 0419U
- 0423U
- 0460U
- 0476U
- 0477U
- 81418
Resources
To learn more about this change, access:
- November medical policy bulletin updates
- Advance Notification and Clinical Submission Requirements
- Training: We offer live training sessions for the genetic and molecular testing prior authorization/advance notification program at 10 a.m. CT on the third Thursday of every other month.
Questions?
If you have questions or to register for a live training, please visit our Genetic and Molecular Testing Prior Authorization/Advance Notification Program website.
PCA-1-24-03108-Clinical-NN_10152024
