Medicaid: View the genetic and molecular codes added to prior authorization requirements

The American Medical Association created new genetic and molecular testing CPT® codes.  As these codes are consistent with genetic and molecular tests which currently require prior authorization, we’re adding them to our genetic testing prior authorization program. Please review your applicable health plan as there are different codes that apply to each. These updates are only applicable to UnitedHealthcare Community Plans in the states outlined below.

UnitedHealthcare Community Plans

Effective July 1, 2025, prior authorization for these new genetic and molecular testing codes will apply to the following UnitedHealthcare Community Plans:

Please visit our Health Plans by State page, select the appropriate state, then Community Plan to view current lists.

How to submit a prior authorization request

You can submit a prior authorization request through the UnitedHealthcare Provider Portal:

• Go to UHCprovider.com and select Sign In at the top-right corner
• Sign in to the portal using your One Healthcare ID and password
  • If you are a new user and don’t have a One Healthcare ID, visit UHCprovider.com/access to get started
• In the menu, select Prior Authorizations
• In the Prior Authorization and Notification tool, scroll down to “Create a new notification or prior authorization request” and click Create New Submissions
• Enter the required information and submit

Resources

For additional program information and live training, please visit our Genetic and Molecular Testing Prior Authorization/Advance Notification Program web page.

Questions?

Chat with us or visit our support resources.