Effective November 1, 2017, UnitedHealthcare will require ordering care providers to request online notification/prior authorization for genetic and molecular lab tests for members who carry UnitedHealthcare Commercial benefit plans.
Certain tests will require ordering care providers to request notification/prior authorization through this process before lab tests can be reimbursed:
• Tier 1 Molecular Pathology Procedures
• Tier 2 Molecular Pathology Procedures
• Genomic Sequencing Procedures
• Multianalyte Assays with Algorithmic Analyses that include Molecular Pathology Testing
• These CPT codes:
- 0009M (prior authorization required starting 1/1/2018)
- S3870 (prior authorization required starting 1/1/2018)
Ordering care providers will need to sign in to UnitedHealthcare’s Link portal and complete the online notification/prior authorization process for tests included in the Genetic and Molecular Lab Test requirement.
If your request meets UnitedHealthcare’s clinical and coverage guidelines, you will get a decision when you submit your request online. If more information or clinical documentation is needed, UnitedHealthcare will contact you.
Care providers can also call BeaconLBS at 800-377-8809 to start the notification/prior authorization process.
The notification/prior authorization requirement is for UnitedHealthcare Commercial benefit plan members. However, it doesn’t apply to care providers in Florida who are subject to the Laboratory Benefit Management Program.
More information is available on UnitedHealthcare's Program Overview page.