Posted in #unitedhealthcare, Training, Updates

UHC: Genetic testing for hereditary cancer-11 codes that are not covered

Ordering Genetic Testing for your patients? Avoid the costly and unnecessary denials with the most up to date medical coding and medical billing guideline information. Below please find the updated information regarding UHC Genetic testing for hereditary cancer information.

There are 11 codes that were added to the list of non-covered, experimental/investigational list.

These codes will be denied, no matter the prior authorization status, as the Genetic Testing for Hereditary Cancer medical policy states, “genetic testing for BRCA1 and BRCA2 or Multi-Gene hereditary panels with RNA testing is unproven.”

The changes are applied to both Commercial and Medicaid Plans.

UHC Commercial Medical Policy. To visit the full policy please click here.

UHC Community Health (Medicaid)Medical Policy. For the full medical policy, please click here.

Partial List of non covered codes:

This change does not affect other BRCA1 testing, BRCA2 testing or multi-gene hereditary cancer panels, which will continue to require prior authorization.

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My name is Kate Patskovska, CPB. I am an Independent Medical Biller CPB (AAPC) and an owner of KR2 Medical Billing. KR2 Medical Billing is a full service Consulting/Medical Billing Business that is dedicated to educating, consulting, and overall improving the "financial health" of your medical practice.

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