UnitedHealthcare Genetic and Molecular Testing Prior Authorization/Notification Requirement
Effective November 1, 2017, UnitedHealthcare began an online prior authorization/notification program for genetic and molecular testing performed in an outpatient setting for their fully insured UnitedHealthcare Commercial Plan members.
Please note that Sonora Quest Laboratories will not perform any testing that meets the specifications listed below without receipt of a prior authorization. If prior authorization is denied, discounted pay at time of service pricing is available through our Patient Service Centers on a variety of tests.
Providers requesting laboratory testing are required to complete the prior authorization/notification process. The process requires providers to indicate the laboratory and test name for the following services:
- 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 included in the prior authorization:
- 0004M – 0008M
- 81161 – 81421
- 81423 – 81479
- 81545 – 81599
For more information, please visit UnitedHealthcareOnline.com or call 877.842.3210.
*The CPT codes provided are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payer being billed.
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