UHC Prior Authorization

Attention: Pathologists, Medical Oncologists/Hematologists, Laboratory Directors, Laboratories, Hospital & Physician Practice Billing Departments

Reminder: UnitedHealthcare Prior Authorization Takes Effect on November 1st

NeoGenomics contracts with national and regional healthcare insurance plans to help offer affordable testing to our clients and patients. Molecular and genetic testing is a rapidly evolving field and has significantly improved patient care. However, many insurance providers have instituted a policy of prior authorization before molecular and genetic testing can be performed to ensure appropriate use.

Starting November 1, 2017, UnitedHealthcare (UHC) will require a new notification/prior authorization process for outpatient genetic and molecular labs test for UnitedHealthcare commercial plan members. This means that certain tests will require ordering providers to request notification/prior authorization through this process before the lab tests can be reimbursed.

The ordering providers will sign in to LINK and complete the online notification/prior authorization process for tests included in the Genetic and Molecular Lab Test requirement. Please refer to the links below to get started.

The online notification/prior authorization process will give care providers a quick coverage determination when their requests for these tests meet UnitedHealthcare clinical guideline criteria.

A list of CPT Codes is below, and virtually all Molecular tests run by NeoGenomics will fall under this new policy. The ordering provider is required to obtain the prior authorization. Samples sent to NeoGenomics requires a prior authorization from UHC Beacon for processing. For more information about the prior authorization process, please refer to the following links on UHC’s website that will help explain the process:

The following UHC plans are currently exempt from prior authorization:

  • Neighborhood Health Partnership (NHP)
  • Sierra Health
  • UHC of the Mid-Atlantic
  • UHC Oxford
  • UHC of the River Valley
  • UHC West
  • UHOne

Prior authorization/notification approval will be required for tests such as:

  • Tier 1 Molecular Pathology Procedures (e.g., BRCA1/2)
  • Tier 2 Molecular Pathology Procedures (e.g., tests for certain genes involved in hereditary cancers)
  • Genomic Sequencing Procedures (e.g., certain CPT codes applicable to hereditary cancer panel tests)
  • Multianalyte Assays with Algorithmic Analyses that include Molecular Pathology Testing (e.g., certain proprietary tests)
  • These CPT® codes:
    • 0001U
    • 0004M - 0008M
    • 81161 - 81421
    • 81423 - 81479
    • 81507
    • 81519
    • 81545 - 81599
    • 0009M (prior authorization required starting Jan. 1, 2018)
    • S3870 (prior authorization required starting Jan. 1, 2018)