BILLING REQUIREMENTS: GENETIC TESTING PROCEDURES

Billing Requirements: Genetic Testing Procedures 03.14

General Guidelines:

Genetic counseling does not require pre- authorization. All Molecular Pathology testing CPT codes 81161- 81479, except those procedures in the Overview of

Billing Instruction table below, will require pre-authorization. Coverage for genetic testing varies by the patient’s plan of benefits.

Overview of Billing Instruction:

SERVICE/PROCEDURE BILLING INSTRUCTION APPLICABLE CODES

1. Molecular Pathology No pre-authorization is required for the following: o Cystic Fibrosis o Prothrombin o Factor V Leiden o Fragile X o Hereditary Hemochromatosis

Cystic Fibrosis: 81200-81224 Prothrombin: 81240 Factor V Leiden: 81241 Fragile X: 81243, 81244 Hereditary Hemochromatosis: 81256

2. FISH for lymphoma or leukemia (e. g. BCR/ABL testing)

No pre-authorization is required if billed with appropriate ICD-9 codes 200.00-208.92

CPT 88269-88275

3. Chromosomal Microarray No pre-authorization is required when used to evaluate children or adults. Note: Chromosomal Microarray for prenatal/fetal diagnosis does require pre-authorization.

CPT codes 81288 and/or 81229

4. Routine chromosomal analysis (e.g. peripheral blood, tissue culture, chorionic villus sampling or aminocentesis)

No pre-authorization required when billed with applicable CPT codes.

CPT 88230-88269; 88280-88299 Note: These codes may require pre-authorization if billed in conjunction with other service codes noted above.