Effective May 1, 2022: Genetic Testing Procedure Codes
Date: 04/01/22
Effective May 1, 2022, prior authorization requests for certain genetic testing procedures for Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS) and CHIP members will utilize Change Healthcare’s InterQual medical necessity review criteria.
Note: Change Healthcare’s InterQual medical necessity review criteria is proprietary but available upon request.
Below are the Current Procedural Terminology (CPT) codes included in this change:
CPT Codes | Description |
|---|---|
81252 | GJB2 GENE ANALYSIS FULL GENE SEQUENCE |
81253 | GJB2 GENE ANALYSIS KNOWN FAMILIAL VARIANTS |
81254 | GJB6 GENE ANALYSIS COMMON VARIANTS |
S3840 | DNA ANALYSIS FOR GERMLINE MUTATIONS OF THE RET PROTO-ONCOGENE |
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.