New AMA genetic testing codes require prior authorization

Effective Jan. 1, 2027, for some UnitedHealthcare commercial and Individual and Family Exchange plans, we’ll require prior authorization for some new procedure codes that the American Medical Association (AMA) has issued for genetic and molecular testing.

These codes are consistent with genetic and molecular tests that currently require prior authorization. Overall, we’re reducing the number of CPT® codes requiring prior authorization, but we may add prior authorization as new information, such as new codes from AMA, becomes available. 

Affected plans

This affects the following plans in all states:

• Neighborhood Health Partnership, Inc.
• UnitedHealthcare Level Funded
• UnitedHealthcare Oxford 
• UnitedHealthcare of the River Valley
• UnitedHealthcare Exchange plans

What’s changing/What you need to know

In addition to the current in-scope procedure codes, the following codes will be added to the existing prior authorization/advance notification requirements:

• 0672U
• 0673U
• 0674U
• 0675U
• 0686U

How to submit and manage prior authorizations

• Sign in to the UnitedHealthcare Provider Portal with your One Healthcare ID
  • If you don’t have a One Healthcare ID, register now
• From the left-hand tabs, select Prior Authorizations & Notifications

For training, view our Prior Authorization and Notification Interactive Guide

If we don’t receive a prior authorization request before the date of service, we’ll deny the claim and you won’t be able to balance bill members.

Resources

• Genetic and molecular testing prior authorization
• UnitedHealthcare commercial and Individual Exchange Medical Policies

Questions? We’re here to help.

If you have questions, please visit our Prior Authorization and Notification resource.