Genetic and molecular testing prior authorization

This program supports appropriate use of evidence-based clinical genetic and molecular testing to help ensure our members have access to quality care. We review services that require prior authorization for clinical coverage based on medical necessity.

For the current list of requirements, visit Advance Notification and Prior Authorization requirements > Current requirements by plan type.

Plans this applies to

Genetic and molecular testing prior authorization requirements apply to the following plans:
 

• UnitedHealthcare commercial plans, including Neighborhood Health Partnership (NHP), UnitedHealthcare Level Funded, UnitedHealthcare Oxford and UnitedHealthcare of the River Valley
• UnitedHealthcare Individual Exchange plans in all states, except for Colorado
• UnitedHealthcare Community plans in Florida, Hawaii, Kansas, Kentucky, Maryland, Michigan, Mississippi, Missouri, Nebraska, New Jersey, New Mexico, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Tennessee, Texas, Virginia, Washington and Wisconsin

Other plans may also have requirements. For more information, refer to the Care Provider Administrative Guides and Manuals.

Resources

• Genetic and molecular lab testing prior authorization/advance notification FAQ
• Genetic and molecular lab test registry FAQ
• Instructions for genetic and molecular test registration
• Genetic and molecular testing prior authorization and advance notification guide