Effective 11/1/26: Removal of Prior Authorization Requirement for Certain Genetic Testing
Date: 10/01/26
Effective November 1, 2026, Superior HealthPlan will no longer require prior authorization for certain genetic testing for Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS), CHIP and Ambetter Health members, below are the Current Procedural Terminology (CPT) codes included in this change to the prior authorization requirements.
Applicable Products: Superior Medicaid (STAR, STAR Kids, STAR+PLUS, STAR Health), CHIP
CPT Code | Description |
81175 | ASXL1 GENE ANALYSIS FULL GENE SEQUENCE |
81307 | PALB2 GENE ANALYSIS FULL GENE SEQUENCE |
81355 | VKORC1 GENE ANALYSIS COMMON VARIANT(S) |
0214U | RARE DS WHL XOM & MITOCHNDRL DNA SEQ ALYS PROBAND |
81171 | AFF2 GENE ANALYSIS EVAL DETECT ABNORMAL ALLELES |
Applicable Products: Ambetter Health (Marketplace)
CPT Code | Description |
0339U | ONC PROSTATE MRNA XPRSN PRFLG HOXC6 & DLX1 RT-PCR |
0349U | RX METAB/PCX DNA 27 GEN VRNT ALYS & PHNT GEN-RX IA |
0363U | ONC URTHL MRNA GEN XPRSN PRFLG RT QUAN PCR 5 GEN |
0391U | ONC SLD TUM DNA & RNA NXT GNJ SEQ FFPE TISS 437 |
0411U | PSYC GENOMIC ALYS PANEL VARIANT ALYS 15 GENES |
0470U | ONC OROP DETCJ MRD NGS QUAN EVAL 8DNA CFHPV16&18 |
0562U | ONC SOL TUM TGSA 33 GENES DETC SNVS CFDNA PLASMA |
Applicable Products: Superior Medicaid (STAR, STAR Kids, STAR+PLUS, STAR Health), CHIP and Ambetter Health (Marketplace)
CPT Code | Description |
81161 | DMD DUPLICATION/DELETION ANALYSIS |
81184 | CACNA1A GENE ANALYSIS EVAL DETECT ABNOR ALLELES |
81189 | CSTB GENE ANALYSIS FULL GENE SEQUENCE |
81209 | BLM GENE ANALYSIS 2281DEL6INS7 VARIANT |
81220 | CFTR GENE ANALYSIS COMMON VARIANTS |
81222 | CFTR GENE ANALYSIS DUPLICATION/DELETION VARIANTS |
81223 | CFTR GENE ANALYSIS FULL GENE SEQUENCE |
81236 | EZH2 GENE ANALYSIS FULL GENE SEQUENCE |
81249 | F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT |
81242 | FANCC GENE ANALYSIS COMMON VARIANT |
81243 | FMR1 GENE ANALYSIS EVAL TO DETECT ABNORMAL ALLELES |
81249 | G6PD GENE ANALYSIS FULL GENE SEQUENCE |
81251 | GBA GLUCOSIDASE/BETA/ACID ANAL COMM VARIANTS |
81257 | HBA1/HBA2 GENE ANALYSIS COMMON DELETIONS/VARIANT |
81259 | HBA1/HBA2 GENE ANALYSIS FULL GENE SEQUENCE |
81269 | HBA1/HBA2 GENE ANALYSIS DUP/DEL VARIANTS |
81271 | HTT GENE ANALYSIS DETECT ABNORMAL ALLELES |
81286 | FXN GENE ANALYSIS FULL GENE SEQUENCE |
81304 | MECP2 GENE ANALYSIS DUPLICATION/DELETION VARIANT |
81319 | PMS2 GENE ANALYSIS DUPLICATION/DELETION VARIANTS |
81321 | PTEN GENE ANALYSIS FULL SEQUENCE ANALYSIS |
81322 | PTEN GENE ANALYSIS KNOWN FAMILIAL VARIANT |
81323 | PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT |
81329 | SMN1 GENE ANALYSIS DOSAGE/DELET ALYS W/SMN2 ALYS |
81336 | SMN1 GENE ANALYSIS FULL GENE SEQUENCE |
81338 | MPL GENE ANALYSIS COMMON VARIANTS |
81351 | TP53 GENE ANALYSIS FULL GENE SEQUENCE |
81352 | TP53 GENE ANALYSIS TARGETED SEQUENCE ANALYSIS |
81361 | HBB COMMON VARIANTS |
81364 | HBB FULL GENE SEQUENCE |
81413 | CAR ION CHNNLPATH GENOMIC SEQ ALYS INC 10 GNS |
81414 | CAR ION CHNNLPATH DUP/DEL GN ALYS PANEL 2 GENES |
81439 | HEREDITARY CARDIOMYOPATHY GEN SEQ ANALYS 5 GEN |
81443 | GENETIC TESTING FOR SEVERE INHERITED CONDITIONS |
0179U | ONC NONSM CLL LNG CA CELL FREE DNA ALYS 23 GEN |
To review prior authorization requirements, please visit Superior’s Prior Authorization webpage.
For questions or additional information, contact Superior’s Prior Authorization department at 1-800-218-7508.