#uhcmedicaid – KR2 Medical Billing

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:

**For the full list of noncovered codes please click here.**

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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This policy is retroactive as of 12/01/2020.

This policy change affects the following plans:

UnitedHealthcare Community Plan for Families (Medicaid)
UnitedHealthcare Community Plan Wellness 4 Me (HARP)

The non-covered codes section clarifies and supplements the UnitedHealthcare Community Plan of New York National Outpatient Physical and Occupational Therapy policy. All other CPT codes for physical and occupational therapy services will be considered non-covered.

Please still check the member benefit plan document that may supersede the additional considerations and coverage limitations and exclusions and prior authorization requirements.

Partial PT/OT covered list: