Colorado Medicaid: Genetic testing covered for prostate cancer
Prior authorization required
Effective July 1, 2023, Health First Colorado covers genetic testing for Medicaid enrollees to help identify the likelihood of developing prostate cancer. The unit limit is 1 per lifetime per member and applies to all provider types. Use CPT® code 0047U when billing for the procedure.
CMS identifies CPT code 0047U as “Oncology (prostate), mRNA, gene expression profiling by real-time RT-PCR of 17 genes (12 content and 5 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a risk score.”
How to submit a request
As required by the state, you must submit a prior authorization request based on the type of service provided and receive approval before starting the procedure. Submit a prior authorization request for behavioral health/physical health (PRIME-RAE) services through the UnitedHealthcare Provider Portal:
Scroll down to “Create a new notification or prior authorization request” and click Create New Submissions
Enter the required information and submit
If we don't receive a prior authorization request before the date of service, the state requires us to deny the claim and you won't be able to balance bill members.
For services related only to physical health (RAE), submit prior authorization requests and claims to Health First Colorado through the Kepro Portal. Visit Health First Colorado or call 720-689-6340 for more information.
Chat with a live advocate 7 a.m.–7 p.m. CT from the UnitedHealthcare Provider Portal. You can also contact UnitedHealthcare Provider Services at 877-842-3210, TTY/RTT 711, 7 a.m.–5 p.m. CT, Monday–Friday.
CPT® is a registered trademark of the American Medical Association.