Navigating Updates for Molecular & Genetic Testing Prior Authorization

Hematologics 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.

Each insurance plan may have a different process for obtaining prior authorization for testing. Please reference several insurance plans and their respective prior authorization policies below. Additional plans and policies will be added in the near future.

Note: Failure to obtain prior authorization may result in delays of processing patient samples.

*For more specific information on the insurance plans you frequently work with, Hematologics recommends calling the patient’s insurance plan for their updated policy.

Additional Resources
  • For additional questions please call 1-800-860-0934
  • United Health Care Prior Authorization Links:
    • UHC 17812 Beacon LBS MG Physician User Guide
    • Prior Authorization Overview
      Link(self service tools)
      FAQS United Healthcare Network Bulletin United Healthcare
      United Health Care Prior Authorization Links
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)