Genetic and Molecular Prior Authorization

Effective July 1, 2020, for UnitedHealthcare Community Plan members in California, Hawaii,  Ohio* and Wisconsin, we will require prior authorization and notification for genetic and molecular testing performed in an outpatient setting.

How It Works:

  1. Use the Genetic and Molecular Lab Test tool on Link to submit your request.
  2. Fill in the member’s information.
  3. Choose the test and lab to perform the test.
  4. Ordering care providers — Submit requests for tests that require authorization.
  5. Labs — Submit your own notification requests for tests that only require notification.
  6. Decisions
    • You’ll get a decision right away if your online request meets UnitedHealthcare’s clinical and coverage guidelines.**
    • If more information or clinical documentation is needed, we’ll contact you.

Approval Will Be Required for the Following:

  • 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:

0001U
0022U – 0023U
0026U – 0034U
0036U – 0037U
0040U
0045U – 0050U
0055U – 0057U
0060U
0068U – 0076U
0078U
0081U
0084U

0087U – 0091U
0094U
0097U – 0100U
0101U – 0103U
0012U – 0014U
0111U
0113U
0115U
0118U
0129U - 0138U
0152U - 0162U
0004M

0006M – 0007M
0011M – 0013M
81105 – 81111
81120 – 81121
81161 – 81210
81212
81215 – 81420
81425 – 81479
0016U – 0019U
81507
81518 – 81522
81542

81545
81552
81595 – 81599
87480 – 87482
87505 – 87507
87510 – 87512
87623
87652
87660 – 87661
87797 – 87801
S3870

You can find more information on the Genetic and Molecular Lab Test tool on Link at UHCprovider.com/genetics.


* For Ohio this change has been delayed until July 1, 2020, not June 1, 2020 as previously announced in the March 2020 Network Bulletin.

** Determinations for notification/prior authorization requests will be made based on UnitedHealthcare’s clinical policy requirements for coverage. Our clinical policies can be found at UHCprovider.com/policies.